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Byline: Indrashis. Podder, Maitrayee. Saha, Anupam. Das, Ramesh. Gharami Sir, The easy bruising syndrome is a condition characterized by recurrent bruising on trivial trauma despite a normal coagulation profile.[sup][1] Some [...]

Byline: Tirthankar. Gayen, Anupam. Das, Kaushik. Shome, Debabrata. Bandyopadhyay Colocalization of diseases in dermatology has always remained elusive and a puzzle, difficult to unscramble. Co-localization of two rare and disparate [...]

The article presents a case study of an 11-year-old boy with vitiligo who experienced significant improvement with topical tofacitinib gel, highlighting its potential as a promising treatment modality for vitiligo in pediatric patients. Topics discussed include the mechanism of action of tofacitinib in vitiligo treatment, the favorable response observed in younger patients with darker skin types, and the possibility of monotherapy with topical tofacitinib without the need for phototherapy.

Although rarely performed today in most centers, Senning procedure continues to be a good option for patients with transposition of great arteries presenting late with either regressed left ventricle or pulmonary hypertension. There are many subsets of patients including those having deficient atrial septal tissue, situs inversus, dextrocardia, and atrial isomerism which require complex modifications of technique. One such subset is patients having bilateral superior vena cavae (SVC), which requires coronary sinus cutback and creating a wide flap for the posterior venous baffle which unduly increases the complexity of the surgery. We describe an alternative way of rerouting a persistent left SVC by reimplanting onto the left atrial appendage which forms the part of the systemic atrium after the atrial switch surgery. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary bypass (CPB) is instituted, during various cardiac operations, to allow for optimal systemic perfusion. Tissue hypoperfusion is associated with lactic acidosis secondary to anaerobic metabolism. Measurement of blood lactate levels can hence be used as a marker to assess the adequacy of tissue perfusion. In this study we tried to find out the association between various preoperative NYHA classes and link their association with perioperative lactate and lactate clearance values. Methods: 100 patients undergoing elective cardiac surgery under cardiopulmonary bypass were included in this prospective observational study. Based on history, the patients were allocated to their respective class as per the New York Heart Association (NYHA) functional classification. Patients aged between 18-80 years posted for elective cardiac surgery under cardiopulmonary bypass were included. For measuring lactate levels, baseline arterial blood was collected from the intra-arterial catheter immediately after induction of anaesthesia. Subsequent samples were collected at intervals of 15 minutes and 45 minutes after institution of CPB, rewarming (at 35°C), immediately after termination of CPB, 24 hours and 48 hours post-surgery. Results: All four NYHA groups were comparable in terms of baseline lactate levels (P value 0.096). Higher mean levels of lactate were seen in NYHA group 4 compared to other three groups during rewarming, termination and post operatively (24 and 48 hours). After 45 minutes of CPB and during rewarming, NYHA 4 group varied significantly from NYHA 1, 2 and 3. In terms of mean lactate clearance, Tukey HSD (Assuming equal variances) post hoc test showed that both NYHA 3 and NYHA 4 were significantly different from each other as well as NYHA group 2. At 24 hours postoperatively, NYHA 2 varied significantly from NYHA 1, 3 and 4. After 48 hours, a significant difference in lactate clearance was seen between NYHA 1 and 2. The duration of inotropic support as well as mechanical ventilation was more in NYHA 3 and 4. Conclusion: There is a definite association between higher mean lactate levels and lactate clearance with a higher NYHA class during the perioperative period. Increased mean lactate levels and lactate clearance is also associated with increased duration of mechanical ventilation and inotropic support. Higher perioperative lactate levels also prolong the ICU and hospital stay in higher NYHA classes. [ABSTRACT FROM AUTHOR]

Introduction: As regard to all pandemics, the current COVID-19 pandemic, could also have been better managed with prudent use of preventive measures coupled with rapid diagnostic tools such as rapid antigen tests, but their efficacy is under question because of projected lower sensitivity as compared to Real Time Reverse Transcriptase Polymerase Chain Reaction, which although considered gold standard has its own limitations. Methodology: A prospective, single centre study was carried out to evaluate the performance of Standard Q COVID-19 Ag, a rapid immunochromatographic assay for antigen detection, against TrueNat, a chip-based, point-of-care, portable, Real-Time PCR analyzer for diagnosis of COVID-19; on 467 nasal swab samples from suspected subjects at a fever clinic in North India in month of July 2020. Results: Of the 467 specimens tested, TrueNat showed positive result in 29 (6.2%), majority of whom were asymptomatic (72.4%) while 4/29 (13.9%) had influenza like illness and 2/29 (6.8%) presented with severe acute respiratory illness. Compared to TrueNat, Rapid antigen test gave concordance for 26 samples, while for 2 samples the result was false positive; giving an overall sensitivity of 89.7% (95% CI = 72.6-97.8) and a specificity of 99.5%, indicating strong agreement between two methods. Conclusion: Community prevalence plays an important role is choosing the laboratory test and result interpretation. Rapid antigen detection tests definitely have a big role to play, especially in resource limited setting, for early diagnosis as well as for source control to halt the spread. [ABSTRACT FROM AUTHOR]

One of the canonical features of the current outbreak of dermatophytosis in India is its unresponsiveness to treatment in majority of cases. Though there appears to be discordance between in vivo and in vitro resistance, demonstration of in vitro resistance of dermatophytes to antifungals by antifungal susceptibility testing is essential as it may help in appropriate management. The practical problem in the interpretation of antifungal susceptibility testing is the absence of clinical breakpoints and epidemiologic cutoff values. In their absence, evaluation of the upper limit of a minimal inhibitory concentration of wild type isolates may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility. In the current scenario, most of the cases are unresponsive to standard dosages and duration of treatment recommended until now. This has resulted in many ex-cathedra modalities of treatment that are being pursued without any evidence. There is an urgent need to carry out methodical research to develop an evidence base to formulate a rational management approach in the current scenario. [ABSTRACT FROM AUTHOR]

Background: Increasing antimicrobial resistance (AMR) among common bacteria combined with the slow development of new antibiotics has posed a challenge to clinicians. Aim and objective: To demonstrate whether antimicrobial and diagnostic stewardship program (ASP and DSP)-related interventions improve antibiotic susceptibilities among common bacteria causing bloodstream infections (BSI) in patients admitted to the intensive care unit (ICU) and whether these resulted in changes in the volume of antimicrobial consumption. Materials and methods: We compared the susceptibility patterns of gram-negative bacteria (GNB) and gram-positive cocci (GPC) causing BSI and changes in the volume of antibiotics prescribed for the same before and after 2017 by a retrospective analysis. Results: Postintervention, there was increased susceptibility of all GNBs to aminoglycosides; Escherichia coli and Klebsiella spp. to beta-lactambeta-lactamase inhibitors (BLBLI) combinations; and Klebsiella spp. and Pseudomonas spp. to carbapenems. Acinetobacter spp., Klebsiella spp., and Pseudomonas spp. showed improved susceptibility to doxycycline, whereas E. coli and Klebsiella spp. showed significantly improved susceptibility to fluoroquinolones. Among GPCs, there was increased susceptibility of Staphylococcus aureus (levofloxacin, clindamycin, and aminoglycoside), coagulase-negative S. aureus (CoNS) (chloramphenicol, levofloxacin, clindamycin, and aminoglycoside), and enterococci (chloramphenicol, levofloxacin, and clindamycin). There was a significant reduction in usage of antimicrobials for the treatment of GPCs (linezolid, doxycycline, chloramphenicol, levofloxacin, BLBLI, macrolide, and cephalosporin) and GNBs (levofloxacin, cephalosporin, carbapenem, and colistin), which caused BSI. Conclusion: The present study illustrated that combined ASP and DSP interventions successfully reversed the resistance pattern of organisms causing BSI and resulted in a reduction in antibiotic utilization. [ABSTRACT FROM AUTHOR]

Byline: Anupam. Das, Indrashis. Podder, Somodyuti. Chandra, Ashim. Mondal, Prabir. Jash, Ramesh. Gharami A 24-year-old non-obese, non-diabetic, normotensive young man presented with a history of gradually enlarging multiple painless nodules [...]

Byline: Anupam. Das, Indrashis. Podder, Dhiraj. Kumar, Anupama. Ghosh, Kaushik. Shome Sir, Cutaneous adverse effects are very commonly seen with a wide plethora of drugs, imatinib mesylate being one of [...]

Byline: Anupam. Das, Dhiraj. Kumar, Swosti. Mohanty, Ashim. Mondal, Satyendra. Chowdhury, Debabrata. Bandyopadhyay Sir, Serpentine supravenous hyperpigmentation (SSH) was the term coined by Hrushesky to describe increased pigmentation of the [...]

Byline: Piyush. Kumar, Anupam. Das, Sushil. Savant A 26-year-old sexually active male presented to us with multiple, grouped, mildly itchy, tiny elevated lesions on the penis for 6 months. The [...]

Byline: Tirthankar. Gayen, Anupam. Das, Kaushik. Shome, Debabrata. Bandyopadhyay, Dipti. Das, Abanti. Saha Granular cell tumor is a distinctly rare neoplasm of neural sheath origin. It mainly presents as a [...]

Byline: Indrashis. Podder, Anupam. Das, Sabari. Bhattacharya, Kaushik. Shome, Satyendra. Chowdhury Palmo-plantar keratodermas (PPKD) are a diverse group of acquired and hereditary disorders, characterized by excessive thickening of the skin [...]

Byline: Dipti. Das, Anupam. Das, Debabrata. Bandyopadhyay, Dhiraj. Kumar Nevus lipomatosus cutaneous superficialis (NLCS) is a benign dermatosis, histologically characterized by the presence of mature ectopic adipocytes in the dermis. [...]

Byline: Anupam. Das, Debabrata. Bandyopadhyay, Vivek. Mishra, Ramesh. Gharami Sir, Progressive cribriform and zosteriform hyperpigmentation (PCZH) refers to an asymptomatic dermatosis characterized by pigmented macules arranged in whorls and streaks [...]

Byline: Dipti. Das, Anupam. Das, Abanti. Saha, Swapan. Sardar, Kaushik. Shome, Ramesh. Gharami A 16-year-old boy born of non-consanguineous marriage presented with numerous solid elevated lesions over his body. To [...]

Byline: Piyush. Kumar, Asma. Parveen, Anupam. Das, Tanumay. Raychaudhury, Indu. Arun A 25-year-old girl presented to us with solitary asymptomatic papule over the left cheek for the last 6 years. [...]

Byline: Anupam. Das, Amrita. Sil, Vivek. Mishra, Nilay. Das Thalidomide developed in 1954 for morning sickness had proven to be a teratogen and hence was withdrawn from market. Resurgence of [...]

Background: Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs. Materials and Methods: An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained. Results: Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in‑patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work. Conclusion: Since the after‑effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs. [ABSTRACT FROM AUTHOR]

Trichophyton (T.) mentagrophytes now accounts for an overwhelming majority of clinical cases in India, a new "Indian genotype" (T. mentagrophytes ITS genotype VIII) having been isolated from skin samples obtained from cases across a wide geographical distribution in this country. The conventional diagnostic methods, like fungal culture, are, however, inadequate for diagnosing this agent. Thus, molecular methods of diagnosis are necessary for proper characterization of the causative agent. The shift in the predominant agent of dermatophytosis from T. rubrum to T. mentagrophytes, within a relatively short span of time, is without historic parallel. The apparent ease of transmission of a zoophilic fungus among human hosts can also be explained by means of mycological phenomena, like anthropization. [ABSTRACT FROM AUTHOR]

Introduction Dermatologists have the skill to identify the conditions by the visual appeal of it. J Dermatol 2020;47:41-6. 20 Ilgen U, Turan S, Emmungil H. Bull's head sign in a patient with SAPHO syndrome. The ever increasing conditions in dermatology and their closeness to a number of other conditions make dermatology an extremely challenging field. [Extracted from the article]

Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei. [ABSTRACT FROM AUTHOR]

Background: Frontline doctors engaged in COVID-19 duties have to adopt enhanced protective measures to minimize their risk of exposure. However, these measures may lead to several skin problems, thereby affecting their performance. Objectives: To analyze skin changes induced by enhanced protective measures and explore possible risk factors. Materials and Methods: A web-based descriptive study was conducted among 212 frontline COVID-19 doctors. Data were collected regarding their demography, duty, use of enhanced protective measures including prophylactic hydroxychloroquine, recent skin changes with affected sites, and possible risk factors. Results: Skin changes were reported by 41.5% of respondents (mean age 34.8 ± 5.6 years) across 210 sites. Hands were involved most commonly in 77.3% of doctors, followed by nasal bridge, cheeks, and retroauricular area. Dryness (84.1%) and skin peeling (79.5%) were the commonest clinical features. Regression model showed prolonged PPE wear (>6 h) adjusted odd's ratio (AOR) 2.9, P = 0.005], heavy sweating [AOR 12.8, P = 0.001] and frequent hand hygiene (>10 times/day) [AOR 3.1, P = 0.0006] to be significant risk factors. Hydroxychloroquine prophylaxis was deemed safe as treatment-emergent adverse events were uncommon (17.4%). Conclusion: Frontline doctors have an increased risk of developing skin damage due to enhanced protective measures. Appropriate steps should be taken to address the risk factors and minimize skin damage. Persistent cases mandate dermatology referral for optimum management. [ABSTRACT FROM AUTHOR]

Anomalous drainage of pulmonary veins into the coronary sinus is an uncommon variety of anomalous pulmonary venous return. Rarely, anomalously draining pulmonary veins may show "dual" drainage. We present the imaging findings of an infant who had dual drainage of a cardiac type of partial anomalous pulmonary venous return in the setting of unroofing of the coronary sinus which has not previously been described. [ABSTRACT FROM AUTHOR]

Population explosion, frequent travel and urbanization have led to certain changes in the environment, which are conducive for the survival of multiple pathogens and their transmission vehicle in the same niche. Therefore, there are more chances of acquiring multiple infections at the same time with overlapping clinical manifestations. We would like to share a case having concurrent infection with four different agents.

135 © 2021 Indian Journal of Dermatology, Venereology and Leprology- Published by Scientific Scholar What is new in dermatotherapy? It may improve pruritus by decreasing peripheral itch sensory neuron signaling through its direct effects on IL-4 and IL-13 and through its effects on eosinophils which results in decreased IL-31 secretion Atopic dermatitis, prurigonodularis, bullous pemphigoid FDA approved for atopic dermatitis in March 2017 Lebrikizumab 17 It is a humanized monoclonal antibody inhibiting IL-13. It is given subcutaneously at 150 mg week 0, 4 and every 12 weeks thereafter Plaque psoriasis FDA approved (April 2019) Bimekizumab 12 It is a human monoclonal IgG antibody against IL-17A and IL-17F. It is given subcutaneously at a loading dose of 320 mg and 160 mg every 4 weeks thereafter Plaque psoriasis, psoriatic arthritis It is in the Phase 3 trial Mirikizumab 13 It is a human monoclonal antibody IgG4 antibody against IL-23. [Extracted from the article]

Dear Editor, Generalized pruritus is a common complaint in elderly, rarely due to Sezary syndrome. Bone marrow studies and immunohistochemistry of skin biopsy has been tabulated (Table 2). European organisation for research and treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome: update 2017. [Extracted from the article]

Chronic spontaneous urticaria (CSU) is a debilitating condition, adversely affecting the patient's quality of life. Bilastine is a recently introduced, non‐sedative H1‐antihistamine for its treatment. We wanted to compare the effectiveness, safety, and tolerability of bilastine 20 mg vs levocetirizine 5 mg in moderate‐to‐severe CSU. We conducted a double‐blind, randomized controlled trial with two groups: bilastine 20 mg (n = 31) and levocetirizine 5 mg (n = 27), once daily for 42 days. We included patients (18‐65 years), with moderate‐to‐severe CSU. UAS7, VAS, and DLQI were used to assess severity of urticaria, global urticaria‐induced discomfort and quality of life, respectively. DLQI was assessed at baseline (D0) and end‐of‐treatment (D42), while UAS7 and VAS were noted at baseline and all follow‐up visits. Assessment of UAS7 alteration was our primary objective, while changes in DLQI and VAS were the secondary outcomes. Safety was assessed by recording drug‐related adverse events, biochemical investigations, and electrocardiogram, along with tolerability and compliance. Both drugs significantly improved UAS7, DLQI, and VAS at end‐of‐treatment (D42) compared with baseline (intra‐group). At the end‐of‐treatment, all parameters showed greater improvement with bilastine, but only UAS7 reduction was significant (bilastine > levocetirizine, P =.03). In both the groups, UAS7 and VAS improved significantly D14 onwards, and was maintained throughout the study. Sedation was significantly less with bilastine (P =.04), while neither drug showed any serious adverse‐effect. Tolerability of both drugs was similar. Therefore, bilastine was found to be a more effective and less‐sedative novel therapy for CSU compared to levocetirizine, with similar effect on quality of life. [ABSTRACT FROM AUTHOR]

SDRIFE (symmetrical drug related intertriginous and flexural exanthem) is a benign self‐limiting adverse drug reaction (ADR) primarily affecting the intertriginous, gluteal and flexural regions symmetrically in the absence of systemic involvement. It is considered to be a variant of baboon syndrome. Pathogenesis is poorly understood but is thought to be result of a delayed hypersensitivity response after exposure to the drug. Commonly implicated drugs are beta‐lactam antibiotics. With the rising incidence of dermatophytosis in the Indian subcontinent, the use of oral anti fungals has become rampant. SDRIFE due to itraconazole has been rarely reported in literature. We hereby present a series of 12 patients presenting with SDRIFE due to itraconazole, which is by far the largest reported in existing literature. This case series highlights the importance of identifying these cutaneous adverse drug reactions in a setting where itraconazole is commonly being used. [ABSTRACT FROM AUTHOR]

In this work we investigate how to extract alternating time bounds from 'focussed' proof systems. Our main result is the obtention of fragments of MALL w (MALL with weakening) complete for each level of the polynomial hierarchy. In one direction we encode QBF satisfiability and in the other we encode focussed proof search, and we show that the composition of the two encodings preserves quantifier alternation, yielding the required result. By carefully composing with well-known embeddings of MALL w into MALL , we obtain a similar delineation of MALL formulas, again carving out fragments complete for each level of the polynomial hierarchy. This refines the well-known results that both MALL w and MALL are PSPACE -complete. A key insight is that we have to refine the usual presentation of focussing to account for deterministic computations in proof search, which correspond to invertible rules that do not branch. This is so that we may more faithfully associate phases of focussed proof search to their alternating time complexity. This presentation seems to uncover further dualities, at the level of proof search, than usual presentations, so could be of proof theoretic interest in its own right. [ABSTRACT FROM AUTHOR]