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The rapid transmission of viral diseases can cause massive economic damage and loss of life. The manufacture of most anti-viral drugs is normally carried out using batch synthesis which typically requires long production times (3–15 days) and significant manpower and infrastructure. The fabrication of fully integrated flow-based manufacturing systems offers an alternative approach that can be greener and more economical. In this regard, we have developed a compact manufacturing machine for the synthesis of the antiviral API daclatasvir which is easily reconfigured, has a much-reduced footprint, and enables multi-step synthesis using innovative reaction chemistry and post-synthesis purification equipment. The developed integrated system enabled the ultra-fast production of DCV as its free base (within 28.2 min.) with a throughput of 11.8 g per day (equivalent to 200 doses of Daklinza, 60 mg tablets) in 98% HPLC purity.

The World Health Organization (WHO) has listed daclatasvir (DCV), symmetrical arene, as one of the essential medicines for human health. DCV manufacturing is usually carried out in a non-continuous or "batch" approach over multiple locations and is severely limited by long production times (3-10 days), resulting in non-affordability (highly expensive) and disruption of the potential chain supply. Here, we report the total process system including the development of a novel electro-flow reactor containing patterned electrodeposited Ni or Pt nanoparticles over a copper electrode for a C-C coupling reaction in a co-reductant/oxidant-free, ultra-fast process for symmetrical substituted/unsubstituted biphenyl synthesis. This method was further extended to a new generation commercial batch synthetic route for continuous flow ultra-fast daclatasvir synthesis in 33.2 min. We envisage that this micro-electro-flow reactor (μ-EFR) system platform will substantially enable advances in continuous-μ-flow fine chemical manufacturing, multistep reaction sequences, reaction devising equipment, and real-time extraction.

Context: Herpes genitalis is a common sexually transmitted disease caused by herpes simplex virus for which no therapy is available which can cure its recurrence. Aims: Comparative evaluation of therapeutic efficacy of topical silver nitrate (AgNO3) in combination with oral levamisole in recurrent herpes genitalis. Methods and Material: A total of 60 patients clinically diagnosed as recurrent herpes genitalis (with 2 or more episodes in last 6 months) with a positive Tzanck smear were divided into 2 groups (test and control) of 30 patients each. Patients in test group were treated with topical application of 10% AgNO3, and then repeated every week, till lesions cleared, or for a maximum of 4 applications along with oral levamisole. In control group distilled water was applied. Patients were followed up for a total period of 24 weeks Results were analysed statistically. Results: In test group only 12 (40%) out of 30 patients showed recurrence, whereas in control group 21 (70%) out of 30 patients showed recurrence. Conclusion: Topical AgNO3 along with oral levamisole has been found to be an effective therapeutic modality not only for treatment but also for preventing recurrence of herpes genitalis and prolonging remissions.

Background: Onychomycosis is a fungal infection of the nail unit and can be caused by dermatophytes, yeasts and non-dermatophyte moulds. None of the treatment modalities yield consistent results. Cryotherapy as a treatment modality has not been studied in its management.Methods: 80 clinically confirmed cases of onychomycosis were enrolled for the study. Cases in group 1 were given liquid nitrogen cryotherapy with dipstick method for 12 weeks at 2 weekly intervals and cases in group 2 were given oral terbinafine in a dose of 500 mg daily for a week/month for 3 months. After 12 weeks cases in both groups were followed up at intervals of 3 weeks till 24 weeks.Results: At week 12 ,40% of the patients in group 1 achieved clinical cure which was comparable to treatment with oral terbinafine pulse which was 45% and G3 response was attained by 20% of the patients in group 1 and 17.5% patients in group 2. The results at 12 weeks were comparable in two groups and p value was insignificant. At the end of study duration, clinical cure was achieved in 32.5% in group 1 and 62.5% of patients in group 2 and p value was highly significant.Conclusions: The results of cryotherapy were inferior to oral terbinafine pulse. Though results with cryotherapy were comparable to oral terbinafine pulse at 12 weeks, at 24 weeks oral terbinafine pulse proved to be a treatment option in finger nail onychomycosis.

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date. Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index. Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine. Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation. Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.

Context: Alopecia areata (AA), an autoimmune disorder, can affect any hair-bearing area. No treatment so far has produced a consistent response. Narrow band ultraviolet B (NBUVB) has not been studied in its management. Aims: Comparative evaluation of intralesional triamcinolone acetonide injection, NBUVB, and their combination in AA. Materials and Methods: Forty patients (28 males and 12 females) with at least three patches of hair loss were enrolled after obtaining written informed consent. Patches were subdivided as follows: Patch 1 was injected with triamcinolone acetonide 2.5 mg/ml (total of three injections) at 3 weeks interval. Patch 2 - NBUVB was given twice a week for a total of 12 weeks. Patch 3 - combination of injection and NBUVB. Therapeutic response was recorded as regrowth of terminal hair (G0 to G4). Statistical Analysis Used: Chi-square test. P < 5% was considered significant. Results: At the end of treatment and follow-up, that is, at week 12, more than 50% of hair regrowth was evident in 27 (67.5%) patients with intralesional steroid; 7 (17.5%) with NBUVB; and 25 (62.5%) patients with their combination. This difference in the clinical response was statistically significant. Conclusions: Intralesional steroid is more effective than NBUVB and their combination is not synergistic in terms of the clinical response in AA.

Circinate balanitis, although a common manifestation of reactive arthritis, is usually an associated finding present along with the triad of arthritis, conjunctivitis, and urethritis. It is rarely seen as the only preceding manifestation of reactive arthritis. We hereby report a case of circinate balanitis as alone preceding presentation of reactive arthritis that was successfully treated with topical pimecrolimus 1% cream.

Condyloma acumianata is one of the most common virally transmitted diseases. Its prevalence has increased many fold throughout the world. Because all the currently available treatments yield low cure rates with side effects, the search for a new alternative continues. Topically, 5-fluorouracil (5-FU) has been in used for many years to treat various skin diseases. When applied topically in condyloma acuminata, 5-FU results in low cure rates with high recurrences. Therefore, intralesional 5% 5-FU is being evaluated to determine its therapeutic efficacy in condyloma acuminata.

Background: Psoriasis is a chronic, autoimmune, inflammatory papulosquamous disorder, the treatment of which remains challenging. A variety of therapeutic modalities have been used with varying degree of success. But, there is no such therapeutic modality till date that can prevent the relapse in psoriasis. Aims: The present study is being undertaken to evaluate the therapeutic efficacy of intralesional 5% 5-fluorouracil (5-FU) as well as its role in preventing relapse in resistant localized plaque psoriasis. Study Design: An open, prospective, randomized-controlled study. Materials and Methods: A total of 40 patients of resistant localized plaque psoriasis were enrolled for the study. Intralesional injection of 5% 5-FU was given in a dosage of 0.1 mL/cm 2 of each plaque using an insulin syringe. In all patients, a single plaque was kept as control and was given intralesional injection of distilled water. A total of three injections were given in each plaque at weekly intervals. After that, patients were followed-up regularly at the interval of 2 weeks up to 12 weeks. All the lesions (both treated and control) were assessed clinically as well as photographically at each visit and graded using psoriasis severity index scoring. Results were analyzed statistically at the end of the follow-up period. Results: At 12 weeks follow-up, out of 40 patients treated, 4 (10%) patients had clearance (>90% resolution), 19 (47.5%) had excellent (70%-90%) improvement, whereas 12 (30%) patients were moderately (30%-70%) improved, and only 5 (12.5%) patients had mild or no improvement. Results were statistically significant in treated group in comparison to control group. Almost all patients complained of pain at the site of injection which subsided within 1-2 h. A total of 10 (25%) patients had necrosis after one or two injections which healed during the follow-up period within 6-8 weeks. Conclusion: Intralesional 5% 5-FU is found to be an effective therapeutic modality in resistant localized plaque psoriasis without much side effects.

Background Vitiligo affects 1% of the world's population with a higher incidence in dark-skinned individuals. Many medical treatments have been attempted with partial success, but recent focus has been on surgical techniques. The aim of this study was to evaluate and compare the therapeutic efficacy of dermabrasion, dermabrasion combined with 5% 5-fluorouracil cream, and dermabrasion combined with topical placentrex gel in the management of localized stable vitiligo. Methods Thirty patients with localized stable vitiligo (at least three lesions each) were treated. After dermabrasion, a soframycin tulle dressing was placed on the first lesion, a topical 5% 5-fluorouracil dressing on the second, and a topical placentrex gel dressing on the third for 7 days after the procedure, and the patients were followed up for 6 months. Results The efficacy of treatment was highest (73.33%) and most rapid in lesions treated with dermabrasion combined with 5-fluorouracil. Dermabrasion alone and dermabrasion combined with placentrex gel showed similar efficacy in localized stable vitiligo. Conclusion Dermabrasion combined with 5-fluorouracil is the most efficacious of the three treatment modalities studied.

Imatinib is a tyrosine kinase inhibitor approved as a first line treatment for chronic myeloid leukemia and gastrointestinal stromal tumors. Usually the drug is well-tolerated with hematological adverse effects being most commonly seen. Dermatological side effects are seen in 9.5-69% of patients on imatinib; majority of which are minor and self-limiting. We, hereby, report a case series of erythroderma occurring secondary to imatinib in two patients with chronic myeloid leukemia. Both the patients improved upon the discontinuation of the drug. The literature review revealed only six probable cases of erythroderma due to imatinib. So, this case series is being reported for the rarity of this adverse effect of imatinib.