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Gupta S, Ramam M, Sharma VK, Sethuraman G, Pandey RM, Bhari N. Reply to "Correspondence on Evaluation of a paraffin based moisturizer compared to a ceramide based moisturizer in children with atopic dermatitis: A double-blind, randomized controlled trial". Pediatr Dermatol 2024; 41:565. [PMID: 38743459 DOI: 10.1111/pde.15530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 05/16/2024]
Affiliation(s)
- Sachin Gupta
- Department of Dermatology, Amrita School of Medicine, Faridabad, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- School of Medical Science and Research, Sharda University, Greater Noida, India
| | - G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Gupta S, Ramam M, Sharma VK, Sethuraman G, Pandey RM, Bhari N. Evaluation of a paraffin-based moisturizer compared to a ceramide-based moisturizer in children with atopic dermatitis: A double-blind, randomized controlled trial. Pediatr Dermatol 2023. [PMID: 37269189 DOI: 10.1111/pde.15355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/30/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Moisturizers are first-line therapy for treatment of atopic dermatitis (AD). Although there are multiple types of moisturizers available, head-to-head trials between different moisturizers are limited. OBJECTIVE To evaluate if a paraffin-based moisturizer is as effective as ceramide-based moisturizer in children with AD. MATERIALS AND METHODS In this double-blind, randomized comparative trial of pediatric patients with mild to moderate AD, subjects applied either a paraffin-based or ceramide-based moisturizer twice daily. Clinical disease activity using SCOring Atopic Dermatitis (SCORAD), quality of life using Children/Infants Dermatology Life Quality Index (CDLQI/IDLQI), and transepidermal water loss (TEWL) were measured at baseline and at follow-up at 1, 3, and 6 months. RESULTS Fifty-three patients were recruited (27 ceramide group and 26 paraffin group) with a mean age of 8.2 years and mean disease duration of 60 months. The mean change in SCORAD at 3 months in the ceramide-based and paraffin-based moisturizer groups was 22.1 and 21.4, respectively (p = .37). The change in CDLQI/IDLQI, TEWL over forearm and back, amount and days of topical corticosteroid required, median time to remission and disease-free days at 3 months were similar in both groups. As the 95% confidence interval (CI) of mean change in SCORAD at 3 months in both groups (0.78, 95% CI: -7.21 to 7.52) was not within the predefined margin of equivalence (-4 to +4), the conclusion of equivalence could not be proven. CONCLUSION Both the paraffin-based and ceramide-based moisturizers were comparable in improving the disease activity in children with mild to moderate AD.
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Affiliation(s)
- Sachin Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- School of Medical Science and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Donohue M, Langford O, Insel P, van Dyck C, Petersen R, Craft S, Sethuraman G, Raman R, Aisen P. Natural cubic splines for the analysis of Alzheimer's clinical trials. Pharm Stat 2023; 22:508-519. [PMID: 36627206 PMCID: PMC10191992 DOI: 10.1002/pst.2285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
Mixed model repeated measures (MMRM) is the most common analysis approach used in clinical trials for Alzheimer's disease and other progressive diseases measured with continuous outcomes over time. The model treats time as a categorical variable, which allows an unconstrained estimate of the mean for each study visit in each randomized group. Categorizing time in this way can be problematic when assessments occur off-schedule, as including off-schedule visits can induce bias, and excluding them ignores valuable information and violates the intention to treat principle. This problem has been exacerbated by clinical trial visits which have been delayed due to the COVID19 pandemic. As an alternative to MMRM, we propose a constrained longitudinal data analysis with natural cubic splines that treats time as continuous and uses test version effects to model the mean over time. Compared to categorical-time models like MMRM and models that assume a proportional treatment effect, the spline model is shown to be more parsimonious and precise in real clinical trial datasets, and has better power and Type I error in a variety of simulation scenarios.
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Affiliation(s)
- M.C. Donohue
- Alzheimer’s Therapeutic Research Institute, University of Southern California California, USA
| | - O. Langford
- Alzheimer’s Therapeutic Research Institute, University of Southern California California, USA
| | - P. Insel
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - C.H. van Dyck
- Alzheimer’s Disease Research Unit, Yale School of Medicine, Connecticut, USA
| | | | - S. Craft
- Department of Internal Medicine–Geriatrics, Wake Forest School of Medicine, North Carolina, USA
| | - G. Sethuraman
- Alzheimer’s Therapeutic Research Institute, University of Southern California California, USA
| | - R. Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California California, USA
| | - P.S. Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California California, USA
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Narayanan A, Bhari N, Sreenivas V, Sharma VK, Sethuraman G. A split-tattoo randomized Q-switched neodymium-doped yttrium-aluminium-garnet laser trial comparing the efficacy of a novel three-pass, one-session method with a conventional method in the treatment of blue/black tattoos in darker skin types. Clin Exp Dermatol 2021; 47:125-128. [PMID: 34236705 DOI: 10.1111/ced.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
Tattoos with blue/black ink show good lightening of pigment after treatment with 1064 nm Q-switched (QS) neodymium-doped yttrium-aluminium-garnet (Nd:YAG) laser. In this randomized trial, we compared the efficacy of a novel three pass, one session procedure (R15 method) with a conventional method for treating blue/black tattoos in darker skin types. Tattoos were treated with 1064 nm QS Nd:YAG Laser with a spot size of 4 mm, fluence of 5 J/cm2 and frequency of 5 Hz. The tattoo pigment lightening was comparable with both methods. Thread-like tattoos had significantly better pigment lightening with fewer side effects than the broad band-like tattoos. We would like to recommend the R15 method of the QS Nd:YAG laser for thread-like tattoos, which can save patients' time, cut short the frequency of their hospital visits and, more importantly, decrease the cost involved in it.
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Affiliation(s)
- A Narayanan
- Department of, Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - N Bhari
- Department of, Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- Department of, Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of, Dermatology, All India Institute of Medical Sciences, New Delhi, India
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Vashisht KR, Arava SK, Tembhre MK, Parihar AS, Sharma VK, Das BK, Sreenivas V, Sethuraman G, Gupta S. A randomized pilot study to compare hair follicle cell suspensions prepared using trypsin alone versus trypsin in combination with collagenase type I for transplantation in vitiligo. Clin Exp Dermatol 2019; 45:172-179. [DOI: 10.1111/ced.14061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/14/2019] [Accepted: 07/26/2019] [Indexed: 01/22/2023]
Affiliation(s)
- K. R. Vashisht
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - S. K. Arava
- Department of Pathology All India Institute of Medical Sciences New Delhi India
| | - M. K. Tembhre
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - A. S. Parihar
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - V. K. Sharma
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - B. K. Das
- Department of Microbiology All India Institute of Medical Sciences New Delhi India
| | - V. Sreenivas
- Department of Biostatistics All India Institute of Medical Sciences New Delhi India
| | - G. Sethuraman
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - S. Gupta
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
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Singh A, Lodha R, Shastri S, Sethuraman G, Sreedevi KN, Kabra M, Kabra SK. Aquagenic Wrinkling of Skin: A Screening Test for Cystic Fibrosis. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1481-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Singh A, Lodha R, Shastri S, Sethuraman G, Sreedevi KN, Kabra M, Kabra SK. Aquagenic Wrinkling of Skin: A Screening Test for Cystic Fibrosis. Indian Pediatr 2019; 56:109-113. [PMID: 30819988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the utility of aquagenic wrinkling as screening test for children with cystic fibrosis. DESIGN Evaluation of diagnostic test. SETTING Pediatric Chest Clinic, and Pediatric Wards of a tertiary care hospital in New Delhi. PARTICIPANTS Three groups (children with cystic fibrosis, carriers of cystic fibrosis, and controls). METHODS Time taken to develop aquagenic wrinkling was measured. The test was performed by asking the enrolled subject to put their one hand in water and was checked for development of wrinkling every minute, and a photograph was also taken every minute. RESULTS A total of 64 children with cystic fibrosis, 64 controls and 64 carriers were enrolled in the study. Median (IQR) time to develop aquagenic wrinkling in the three groups was 2 (2.5,3) minutes, 4 (3,5) minutes and 8 (5,11) minutes, respectively. The optimal cut-off was calculated as 3 minutes by Receiver operating characteristic curve with a sensitivity and specificity for identification of children with cystic fibrosis as 81% and 57%, respectively. The area under curve was 76.5%. The 3 minute cut-off for development of aquagenic wrinkling was applied to 54 children referred for sweat test. 20 children had sweat chloride values of ≥60 mEq/l and diagnosed as cystic fibrosis. 15 of these developed aquagenic wrinkling at ≤3 minutes, giving a sensitivity of 75%. CONCLUSIONS In places with no facility for sweat test, children with phenotype compatible with cystic fibrosis who develop aquagenic wrinkling in 3 minutes may be diagnosed as probable cystic fibrosis and referred for confirmation by sweat test.
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Affiliation(s)
- Anuj Singh
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Shivaram Shastri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - K N Sreedevi
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence: Dr SK Kabra, Professor, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Marwaha RK, Mithal A, Bhari N, Sethuraman G, Gupta S, Shukla M, Narang A, Chadda A, Gupta N, Sreenivas V, Ganie MA. Supplementation with Three Different Daily Doses of Vitamin D3 in Healthy Pre-pubertal School Girls: A Cluster Randomized Trial. Indian Pediatr 2018; 55:951-956. [PMID: 30587642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the adequacy and efficacy of different doses of vitamin D3 in pre-pubertal girls. DESIGN Cluster Randomized controlled trial. SETTING Public school in Delhi, India, between August 2015 and February 2016. PARTICIPANTS 216 healthy pre-pubertal girls, aged 6.1-11.8 years. INTERVENTION Daily supplementation with 600 IU (n=74), 1000 IU (n=67) or 2000 IU (n=75) of vitamin D3 under supervision for 6 months. OUTCOME MEASURES Primary: Rise in serum 25 hydroxy Vitamin D (25(OH)D); Secondary: Change in bone formation and resorption markers. RESULTS Following 6 months of supplementation, the mean (SD) rise in serum 25(OH)D was maximum with 2000 IU (24.09 (8.28) ng/mL), followed by with 1000 IU (17.96 (6.55) ng/mL) and 600 IU (15.48 (7.00) ng/mL). Serum 25(OH)D levels of ≥20 ng/mL were seen in 91% in 600 IU group , 97% in 1000 IU group and 100% in 2000 IU group. The overall mean (SD) rise in urinary calcium creatinine ratio (0.05 (0.28) to 0.13 (0.12) mg/mg), and serum procollagen type I N-terminal propeptide (538.9 (199.78) to 655.5 (218.24) ng/mL), and reduction in serum carboxy-terminal telopeptide (0.745 (0.23) to 0.382 (0.23) ng/mL) was significant (P<0.01). The change in the above parameters was comparable among the three groups after adjustment for age. CONCLUSIONS Daily vitamin D supplementation with 600 IU to 2000 IU for 6 months results in Vitamin D sufficiency in >90% of pre-pubertal girls.
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Affiliation(s)
- Raman Kumar Marwaha
- International Life Sciences Institute, India. Correspondence to: Maj Gen Raman Kumar Marwaha, Scientific Advisor (Projects), International Life Science Institute (India).
| | - A Mithal
- Medanta Hospital Gurgaon, Haryana, India
| | - Neetu Bhari
- Department of Dermatology, AIIMS, New Delhi, India
| | - G Sethuraman
- Department of Dermatology, AIIMS, New Delhi, India
| | | | | | | | - Aditi Chadda
- Dr BR Sur Homeopathic Medical College, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology, AIIMS, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, AIIMS, New Delhi, India
| | - M A Ganie
- Department of Endocrinology, AIIMS, New Delhi, India
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Yenamandra VK, Shamsudheen KV, Madhumita RC, Rijith J, Ankit V, Scaria V, Sridhar S, Kabra M, Sharma VK, Sethuraman G. Autosomal recessive epidermolysis bullosa simplex: report of three cases from India. Clin Exp Dermatol 2018; 42:800-803. [PMID: 28925504 DOI: 10.1111/ced.13182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- V K Yenamandra
- Departments of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - K V Shamsudheen
- CSIR Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India.,Academy of Scientific and Innovative Research, CSIR, New Delhi, India
| | - R C Madhumita
- Departments of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - J Rijith
- CSIR Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - V Ankit
- CSIR Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - V Scaria
- CSIR Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India.,Academy of Scientific and Innovative Research, CSIR, New Delhi, India
| | - S Sridhar
- CSIR Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India.,Academy of Scientific and Innovative Research, CSIR, New Delhi, India
| | - M Kabra
- Departments of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V K Sharma
- Departments of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - G Sethuraman
- Departments of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Patra S, Sethuraman G, Kumar R. Turban Tumor: A Classical Presentation of Brooke-Spiegler Syndrome. Indian Dermatol Online J 2018; 9:284-285. [PMID: 30050828 PMCID: PMC6042198 DOI: 10.4103/idoj.idoj_320_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Suman Patra
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Yenamandra VK, Moss C, Sreenivas V, Khan M, Sivasubbu S, Sharma VK, Sethuraman G. Development of a clinical diagnostic matrix for characterizing inherited epidermolysis bullosa. Br J Dermatol 2017; 176:1624-1632. [PMID: 27925151 DOI: 10.1111/bjd.15221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Accurately diagnosing the subtype of epidermolysis bullosa (EB) is critical for management and genetic counselling. Modern laboratory techniques are largely inaccessible in developing countries, where the diagnosis remains clinical and often inaccurate. OBJECTIVES To develop a simple clinical diagnostic tool to aid in the diagnosis and subtyping of EB. METHODS We developed a matrix indicating presence or absence of a set of distinctive clinical features (as rows) for the nine most prevalent EB subtypes (as columns). To test an individual patient, presence or absence of these features was compared with the findings expected in each of the nine subtypes to see which corresponded best. If two or more diagnoses scored equally, the diagnosis with the greatest number of specific features was selected. The matrix was tested using findings from 74 genetically characterized patients with EB aged > 6 months by an investigator blinded to molecular diagnosis. For concordance, matrix diagnoses were compared with molecular diagnoses. RESULTS Overall, concordance between the matrix and molecular diagnoses for the four major types of EB was 91·9%, with a kappa coefficient of 0·88 [95% confidence interval (CI) 0·81-0·95; P < 0·001]. The matrix achieved a 75·7% agreement in classifying EB into its nine subtypes, with a kappa coefficient of 0·73 (95% CI 0·69-0·77; P < 0·001). CONCLUSIONS The matrix appears to be simple, valid and useful in predicting the type and subtype of EB. An electronic version will facilitate further testing.
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Affiliation(s)
- V K Yenamandra
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - C Moss
- Department of Dermatology, Birmingham Children's Hospital, Birmingham, U.K
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - M Khan
- Sadd Maareb Medical Centre, Abu Dhabi, U.A.E
| | - S Sivasubbu
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - V K Sharma
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- Deepak Juyal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Yadav
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Kumar
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Trupti Shende
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Marwaha RK, Yenamandra VK, Sreenivas V, Sahay R, Baruah MP, Desai A, Kurvilla S, Joseph S, Unnikrishnan AG, Lakshmy R, Apoorva C, Sharma VK, Sethuraman G. Regional and seasonal variations in ultraviolet B irradiation and vitamin D synthesis in India. Osteoporos Int 2016; 27:1611-1617. [PMID: 26630977 DOI: 10.1007/s00198-015-3427-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Evaluation of ultraviolet B index (UVBI) and its impact on vitamin D synthesis is important. We observed the maximum UVBI between 11 am and 1 pm. There was no increase in serum 25(OH)D levels following sun exposure during winter as the UVBI was significantly low, emphasizing the need for vitamin D supplementation during these months. INTRODUCTION The amount of vitamin D3 synthesizing UVB irradiation (290-320 nm) reaching the earth's surface at different altitudes and seasons in different parts of India and it's impact on vitamin D synthesis has not been well studied. METHODS The hourly UVB index (UVBI) from 10 am to 3 pm everyday for 12 months was measured by a solar meter in 4 different zones (North, Northeast, West and South) of the country. To study the impact of sun light exposure on vitamin D synthesis during winter, healthy school children aged 10-15 years were exposed to sunlight for a period of 30 min per day, between 11 am to 12 noon with 10 % body surface area, for 4 weeks. The main outcome measures were serum 25(OH)D, PTH, calcium, phosphate, and alkaline phosphatase levels before and after sun exposure. RESULTS The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. The highest UVBI was recorded from the North zone (4.5 ± 2.7 μW/Cm(2)), while the least was recorded in the Northeast zone (2.1 ± 1.2 μW/Cm(2)). UVBI readings in the Northeast zone were consistently low throughout the year, while all the other three zones showed significant seasonal fluctuations. Surprisingly, we observed a significant decrease in serum 25(OH)D levels from baseline (6.3 ± 4.6 to 5.1 ± 2.7 ng/mL; p < 0.001) despite sun exposure. CONCLUSION The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. No increase in the serum 25(OH)D levels was observed following sun exposure in winter, emphasizing the need for vitamin D supplementation during these months.
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Affiliation(s)
- R K Marwaha
- International Life Sciences Institute, New Delhi, India
| | - V K Yenamandra
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - A Desai
- Endocrine Unit, Department of Medicine, Goa Medical College, Bambolim Goa, India
| | - S Kurvilla
- Christian Fellowship Hospital, Oddanchatram, Dindigul, India
| | - S Joseph
- Christian Fellowship Hospital, Oddanchatram, Dindigul, India
| | | | - R Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - C Apoorva
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V K Sharma
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Sharma V, Bhari N, Gupta S, Sahni K, Khanna N, Ramam M, Sethuraman G. Author reply: Biologics or biosimilars: What is the difference? Indian J Dermatol Venereol Leprol 2016; 82:684-686. [DOI: 10.4103/0378-6323.191539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma V, Bhari N, Gupta S, Sahni K, Khanna N, Ramam M, Sethuraman G. Clinical efficacy of rituximab in the treatment of pemphigus: A retrospective study. Indian J Dermatol Venereol Leprol 2016; 82:389-94. [DOI: 10.4103/0378-6323.174379] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marwaha RK, Sreenivas V, Talwar D, Yenamandra VK, Challa A, Lakshmy R, Sharma VK, Sethuraman G. Impact of solar ultraviolet B radiation (290-320 nm) on vitamin D synthesis in children with type IV and V skin. Br J Dermatol 2015; 173:604-6. [PMID: 25939893 DOI: 10.1111/bjd.13887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- R K Marwaha
- Department of Endocrinology, International Life Sciences Institute (ILSI, India), New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - D Talwar
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Yenamandra
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - A Challa
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - R Lakshmy
- Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
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Ramesh V, Sen MK, Sethuraman G, D'Souza P. Cutaneous tuberculosis due to multidrug-resistant tubercle bacilli and difficulties in clinical diagnosis. Indian J Dermatol Venereol Leprol 2015; 81:380-4. [PMID: 25994882 DOI: 10.4103/0378-6323.157447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This report describes 6 HIV-negative patients including 5 children with scrofuloderma and an adult with lupus vulgaris, out of a total of 303 cases of cutaneous tuberculosis seen during a 4½-year period, who showed a positive tuberculin test and granulomatous histopathology, but failed to respond to first-line antitubercular therapy. They were suspected to have multidrug-resistant infection as no other cause could be ascertained. Tissue aspirate or biopsy was sent for histopathology and culture. Mycobacterium tuberculosis was isolated from the aspirate in three patients and sputum in one with associated pulmonary tuberculosis. Drug susceptibility tests showed that all isolates were resistant to rifampicin and isoniazid, and one each additionally to streptomycin and ethambutol, respectively. In two, culture was unsuccessful. All were administered second-line antitubercular drugs. Clinical improvement was appreciable within 2 months as weight gain, and regression of ulcers, swellings and plaques. Two completed the recommended 24 months of therapy. Multidrug-resistant cutaneous tuberculosis should be suspected in patients with no response to first-line drugs, with clinical deterioration, and where other causes of treatment failure are not forthcoming. Owing to poor isolation rates on culture and low sensitivity of molecular tests, in such cases, a trial of second-line anti-tubercular drugs may be justified for a reasonable period of 2 months. Where facilities permit, culture and drug sensitivity tests should be done before starting treatment. Culture positivity is better from aspirated material.
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Affiliation(s)
- V Ramesh
- Department of Dermatology, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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Bhari N, Chiramel MJ, Vedi KK, Nath D, Sandip S, Kumar R, Kumar L, Sharma VK, Sethuraman G. Necrobiotic xanthogranuloma with multiple myeloma. Clin Exp Dermatol 2015; 40:811-4. [DOI: 10.1111/ced.12620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- N. Bhari
- Department of Dermatology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - M. J. Chiramel
- Department of Dermatology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - K. K. Vedi
- Department of Dermatology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - D. Nath
- Department of Pathology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - S. Sandip
- Department of Radiodiagnosis; All India Institute of Medical Sciences; New Delhi 110029 India
| | - R. Kumar
- Department of Nuclear Medicine; All India Institute of Medical Sciences; New Delhi 110029 India
| | - L. Kumar
- Department of Medical Oncology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - V. K. Sharma
- Department of Dermatology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - G. Sethuraman
- Department of Dermatology; All India Institute of Medical Sciences; New Delhi 110029 India
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Verma K, Sethuraman G, Kalavani M. Weekly azathioprine pulse versus daily azathioprine in the treatment of Parthenium dermatitis: A non-inferiority randomized controlled study. Indian J Dermatol Venereol Leprol 2015; 81:251-6. [DOI: 10.4103/0378-6323.154788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sethuraman G, Sreenivas V, Yenamandra VK, Gupta N, Sharma VK, Marwaha RK, Bhari N, Irshad M, Kabra M, Thulkar S. Threshold levels of 25-hydroxyvitamin D and parathyroid hormone for impaired bone health in children with congenital ichthyosis and type IV and V skin. Br J Dermatol 2014; 172:208-14. [PMID: 24864027 DOI: 10.1111/bjd.13131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with congenital ichthyosis, especially those with darker skin types, are at increased risk of developing vitamin D deficiency and rickets. The relationships between 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH) and bone health have not been studied previously, in ichthyosis. OBJECTIVES To determine the threshold levels of 25(OH)D and PTH for impaired bone health in children with congenital ichthyosis. METHODS In this cross-sectional study, 119 children with ichthyosis and 168 controls were recruited. Serum 25(OH)D, PTH, calcium, phosphate and alkaline phosphatase (ALP) were measured. Radiological screening for rickets was carried out only in children with ichthyosis. RESULTS Forty-seven children with ichthyosis had either clinical or radiological evidence of rickets. The correlation between serum 25(OH)D and PTH showed that a serum level of 25(OH)D 8 ng mL(-1) was associated with a significant increase in PTH. The correlation between PTH and ALP showed that a serum PTH level of 75 pg mL(-1) was associated with a significant increase in ALP levels. Of the different clinical phenotypes of ichthyosis, both autosomal recessive congenital ichthyosis (ARCI) and epidermolytic ichthyosis (EI) were found to have significantly increased PTH, ALP and radiological rickets scores compared with common ichthyosis. CONCLUSIONS Serum levels of 25(OH)D ≤ 8 ng mL(-1) and PTH ≥ 75 pg mL(-1) significantly increases the risk for development of rickets [odds ratio (OR) 2·8; 95% confidence interval (CI) 1·05-7·40; P = 0·04] in ichthyosis. Among the different types, patients with ARCI (OR 4·83; 95% CI 1·74-13·45; P < 0·01) and EI (OR 5·71; 95% CI 1·74-18·79; P < 0·01) are at an increased risk of developing rickets.
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Affiliation(s)
- G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Lai-Cheong J, Sethuraman G, Ramam M, Stone K, Simpson M, McGrath J. Recurrent heterozygous missense mutation, p.Gly573Ser, in the TRPV3 gene in an Indian boy with sporadic Olmsted syndrome. Br J Dermatol 2012; 167:440-2. [DOI: 10.1111/j.1365-2133.2012.11115.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chouhan K, Sethuraman G, Gupta N, Sharma V, Kabra M, Khaitan B, Sreenivas V, Ramam M, Kusumakar S, Thulkar S, Paller A. Vitamin D deficiency and rickets in children and adolescents with ichthyosiform erythroderma in type IV and V skin. Br J Dermatol 2012; 166:608-15. [DOI: 10.1111/j.1365-2133.2011.10672.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khatri R, Mukhopadhyay K, Verma K, Sethuraman G, Sharma A. Genetic predisposition to parthenium dermatitis in an Indian cohort due to lower-producing genotypes of interleukin-10 (−) 1082 G>A and (−) 819 C>T loci but no association with interferon-γ (+) 874 A>T locus. Br J Dermatol 2011; 165:115-22. [DOI: 10.1111/j.1365-2133.2011.10248.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kaur J, Sharma VK, Sethuraman G, Tejasvi T. Comparison of the efficacy of psoralen ultraviolet A with narrowband ultraviolet B phototherapy for the treatment of chronic plaque psoriasis in patients with skin types IV and V. Clin Exp Dermatol 2008; 33:513-5. [DOI: 10.1111/j.1365-2230.2008.02718.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhowmik D, Dinda AK, Xess I, Sethuraman G, Mahajan S, Gupta S, Agarwal SK, Guleria S, Tiwari SC. Fungal panniculitis in renal transplant recipients. Transpl Infect Dis 2007; 10:286-9. [PMID: 18086276 DOI: 10.1111/j.1399-3062.2007.00293.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Panniculitis may result due to various etiologies. In post-transplant immunosuppressed patients infection is the foremost cause of panniculitis. We present 2 cases of fungal panniculitis in renal transplant recipients. The first patient presented with non-tender firm erythematous plaques on the left thigh. Biopsy showed panniculitis with cryptococci. Subsequent investigations revealed the presence of cryptococcal antigens in the blood, urine, and bronchoalveolar lavage fluid. There was no evidence of cryptococcal meningitis. The second patient complained of subcutaneous nodules on the trunk and right thigh. Biopsy of one of the nodules showed panniculitis with histoplasma. This patient had been treated earlier (inadequately) for disseminated histoplasmosis. Both the cases responded well to conventional amphotericin B therapy. Their renal functions remained stable.
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Affiliation(s)
- D Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
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Sethuraman G, Khaitan B, Dash S, Chandramohan K, Sharma V, Kabra M, Verma K, Goswami R, Thulkar S. Ichthyosiform erythroderma with rickets: report of five cases. Br J Dermatol 2007; 158:603-6. [DOI: 10.1111/j.1365-2133.2007.08355.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baba CS, Sharma PK, Deo V, Pal S, Sethuraman G, Gupta SD, Makharia GK. Association of Ehlers-Danlos syndrome and solitary rectal ulcer syndrome. Indian J Gastroenterol 2007; 26:149-50. [PMID: 17704597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kryzhanovskaya L, Carlson G, DelBello M, Findling R, Kowatch R, Schulz S, Robertson-Plouch C, Xu W, Sethuraman G, Carlson J, Tohen M. Changes in metabolic parameters in olanzapine-treated adolescents with schizophrenia or bipolar I disorder: A pooled analysis of 4 studies. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sharma VK, Prasad HRY, Sethuraman G, Khaitan BK. Combination of sodium stibogluconate and rifampicin in post kala-azar dermal leishmaniasis. Indian J Dermatol Venereol Leprol 2007; 73:53-4. [PMID: 17314452 DOI: 10.4103/0378-6323.30657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sethuraman G, Malhotra AK, Khaitan BK, Sharma VK, Kumar R, Makharia GK, Vinod BN, Sharma SK, Goswami R, Bandhu S. Familial pachydermoperiostosis in association with protein-losing enteropathy. Clin Exp Dermatol 2006; 31:531-4. [PMID: 16716156 DOI: 10.1111/j.1365-2230.2006.02138.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this report we describe a rare association of pachydermoperiostosis with protein-losing enteropathy (PLE) in a family of three brothers. The first brother had the complete form of pachydermoperiostosis along with PLE. The second brother had the 'forme fruste' of pachydermoperiostosis, with minimal skin changes, bony abnormalities and PLE, which was due to intestinal lymphangiectasia. The third brother had an incomplete form of pachydermoperiostosis without evidence of PLE. To our knowledge, the association of pachydermoperiostosis with PLE due to intestinal lymphangiectasia has not been reported previously.
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Affiliation(s)
- G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Osteoma cutis is the formation of normal bone in the skin. Primary osteoma cutis occurs de novo, whereas the secondary type develops in association with the underlying inflammatory, tumorous or traumatic conditions. Primary osteoma cutis is also associated with Albright's hereditary osteodystrophy (AHO), which can include hypocalcaemic-type pseudohypoparathyroidism (also known as pseudohypoparathyroidism type Ia) or normocalcaemic-type pseudohypoparathyroidism (also known as pseudopseudohypoparathyroidism). We describe a case of osteoma cutis in a 7-year-old boy who had cutaneous, biochemical and phenotypic features of pseudohypoparathyroidism type Ia and AHO.
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Affiliation(s)
- G Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India.
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33
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Verma K, Bansal A, Sethuraman G. Response by authors. Indian J Dermatol Venereol Leprol 2006. [DOI: 10.4103/0378-6323.25792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Parthenium dermatitis is a serious problem in India. Corticosteroids are the mainstay of treatment but the prolonged use of corticosteroids can cause serious side effects. Azathioprine used in daily doses has been shown to be effective. AIM We have evaluated the effectiveness of azathioprine weekly pulse doses for the treatment of parthenium dermatitis. METHODS Twelve patients, ten males and two females, aged between 39 and 65 years (mean +/- SD = 53.5 +/- 8.7) having air-borne contact dermatitis to Parthenium hysterophorus for 3-19 years (mean = 6.33) were included in the study. The diagnosis in each patient was confirmed by patch-testing. The severity of the disease was determined by clinical severity score (CSS) on the basis of erythema, itching, type of lesions, and areas of body involved. RESULTS The pretreatment CSS in these patients varied from 29.7 to 55.5 (mean +/- SD: 40.40 +/- 7.95). After clinical and laboratory evaluation, the patients were treated with 300-mg azathioprine once-weekly doses for 6 months. Clinical and laboratory evaluations were repeated at weeks 1, 2, and then every 4 weeks until the end of therapy to evaluate the therapeutic response and side effects. The response was excellent (80-100% clearance of disease) in seven (58.33%) patients and good (60% clearance) in five (41.66%) patients. The post-treatment CSS decreased from the mean +/- SD of 40.4 +/- 7.95 to 10.9 +/- 8.43 (P = 0.002). There were no significant side effects of the therapy. CONCLUSIONS In this preliminary open study, azathioprine in weekly pulse doses has been found to be effective without any serious adverse effects in the treatment of parthenium dermatitis. The cost of therapy with this regimen is reduced by 60%.
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Affiliation(s)
- Kaushal K Verma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
A 23-year-old man presented with annular and arcuate, hyperpigmented, itchy, scaly plaques over the trunk and lower extremities for 5 years progressing to verrucous papules and nodules for the last 1.5 years. He also had nontender, inguinal and axillary lymphadenopathy. Skin and lymph node biopsies showed granulomatous inflammation and special stains demonstrated long septate hyphae. Tissue cultures grew Trichophyton verrucosum. The patient was treated with itraconazole 100 mg twice daily for 8 months, resulting in complete clearance of the lesions.
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Affiliation(s)
- T Tejasvi
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Sethuraman G, Fassihi H, Ashton GHS, Bansal A, Kabra M, Sharma VK, McGrath JA. An Indian child with Kindler syndrome resulting from a new homozygous nonsense mutation (C468X) in the KIND1 gene. Clin Exp Dermatol 2005; 30:286-8. [PMID: 15807691 DOI: 10.1111/j.1365-2230.2004.01712.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kindler syndrome is an inherited skin condition that presents with blistering followed by photosensitivity and a progressive poikiloderma. The disorder results from mutations in the KIND1 gene, encoding the protein kindlin-1, a recently characterized 677-amino acid protein involved in anchorage of the actin cytoskeleton to the extracellular matrix. We report the clinical features of an 11-year-old boy with Kindler syndrome from a consanguineous Indian family and the identification of a homozygous nonsense mutation (C468X) in exon 12 of the KIND1 gene in his genomic DNA. This mutation has not been described previously but is similar to the 17 previously published KIND1 mutations that are all predicted to lead to loss of kindlin-1 protein expression and function. The clinical features in this boy highlight the relevance of kindlin-1 in skin biology, specifically to epidermal adhesion and response to acute and chronic sun exposure. Delineation of this new pathogenic mutation in KIND1 is also useful for genetic counselling in this family and in assessing carrier status in unaffected family members.
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Affiliation(s)
- G Sethuraman
- Department of Dermatology and Venereology, New Delhi, India
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38
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Manchanda Y, Sethuraman G, Paderwani PPS, Singh M, Singh MK. Molluscum contagiosum presenting as penile horn in an HIV positive patient. Br J Vener Dis 2005; 81:183-4. [PMID: 15800105 PMCID: PMC1764681 DOI: 10.1136/sti.2004.010686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE To determine whether pergolide, a mixed D1/D2/D3 dopamine agonist, is efficacious and safe in the treatment of children with chronic tic disorders and Tourette syndrome. BACKGROUND Neuroleptics, which block dopamine transmission, are currently used to treat children with severe tics, but major side effects and limited efficacy reduce clinical utility. Prior open-label and crossover studies of pergolide suggest potential benefit. METHODS The authors enrolled 57 children and adolescents, ages 7 to 17 years, randomizing them in a 2:1 ratio to either pergolide (0.15 to 0.45 mg per day) or placebo. Tic symptoms had to be >30 on the Yale Global Tic Severity Scale (YGTSS). The primary outcome measure was change in tic severity assessed by YGTSS. RESULTS Compared to placebo treatment, pergolide treatment was associated with lower tic severity scores (treatment effect 8.8, pergolide vs placebo; 95% CI 0.1 to 17.6; p = 0.05) and attention-deficit hyperactivity disorder symptoms scores (treatment effect 3.8; 95% CI 0.7 to 6.8; p = 0.02). No patient had a serious adverse event and pergolide was well tolerated. CONCLUSIONS In this randomized, placebo-controlled trial, pergolide appeared to be an efficacious and safe medication for tic reduction in children, and may also improve attention-deficit hyperactivity disorder symptoms.
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Affiliation(s)
- D L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA.
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40
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Abstract
Dyschromatosis universalis hereditaria is a clinically heterogenous disorder. We report two unrelated Indian patients with dyschromatosis universalis hereditaria, who had generalized and progressive reticulate hyper- and hypo-pigmentation of the skin. The oral mucosa and tongue also showed mottled pigmentation. Intriguingly, the palms and soles were also affected with a diffuse hyper-pigmentation interspersed with spotty de-pigmented macules. Dystrophic nail changes with pterygium formation were seen in one case. Histopathology revealed a variable degree of pigmentary incontinence. Although the precise aetiology of this disorder is not yet known, the clinicopathological findings implicate an inherent abnormality of melanosomes or melanin processing.
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Affiliation(s)
- G Sethuraman
- Department of Dermatology, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India.
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41
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Thirumurthy M, Sethuraman G, Srinivas CR. KOH mount for superficial fungal infections using cellophane tape: comparison with standard technique. Indian J Dermatol Venereol Leprol 2002; 68:136. [PMID: 17656909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Fifteen patients with superficial fungal infections (tinea versicolor--9, dermatophytic infections--6) were included in this study. Skin scrapings were collected directly on to the glass slide and also by using cellophane tape. Both the samples were mounted with KOH. Fungal elements were detected by both the methods in all cases and was better visualised by the tape method.
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Affiliation(s)
- M Thirumurthy
- Department of Dermatology, PSG Institute of Medical Sciences & Research, Peelamedu, Coimbatore-641 004, Tamil Nadu, India
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Franz DN, Brody A, Meyer C, Leonard J, Chuck G, Dabora S, Sethuraman G, Colby TV, Kwiatkowski DJ, McCormack FX. Mutational and radiographic analysis of pulmonary disease consistent with lymphangioleiomyomatosis and micronodular pneumocyte hyperplasia in women with tuberous sclerosis. Am J Respir Crit Care Med 2001; 164:661-8. [PMID: 11520734 DOI: 10.1164/ajrccm.164.4.2011025] [Citation(s) in RCA: 215] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH) produce cystic and nodular disease, respectively, in the lungs of patients with tuberous sclerosis. The objective of this study was to prospectively characterize the prevalence, clinical presentation, and genetic basis of lung disease in TSC. We performed genotyping and computerized tomographic (CT) scanning of the chest on 23 asymptomatic women with tuberous sclerosis complex (TSC). Cystic pulmonary parenchymal changes consistent with LAM were found in nine patients (39%). These patients tended to be older than cyst-negative patients (31.9 +/- 7.6 yr versus 24.8 +/- 11.6 yr, p = 0.09). There was no correlation between presence of cysts and tobacco use, age at menarche, history of pregnancy, or estrogen-containing medications. Three of the cyst-positive patients had a prior history of pneumothorax. Pulmonary function studies revealed evidence of gas trapping but normal spirometric indices in the cyst-positive group. All nine cyst-positive patients had angiomyolipomas (AML), which were larger (p < 0.05) and more frequently required intervention (p = 0.08) than cyst-negative patients (8 of 14 with AMLs, p < 0.05). Ten patients (43%) had pulmonary parenchymal nodules. Pulmonary nodules were more common in women with cysts (78% versus 21%, p < 0.05), and 52% of all patients had either cystic or nodular changes. TSC2 mutations were identified in all cyst-positive patients who were tested (n = 8), whereas both TSC1 and TSC2 mutations were found in patients with nodular disease. Correlation of the mutational and radiographic data revealed one pair of sisters who were discordant for cystic disease, two mother- daughter pairs who were discordant for nodular disease, and no clear association between cyst development and a specific mutational type. This prospective analysis demonstrates that cystic and nodular pulmonary changes consistent with LAM and MMPH are common in women with TSC.
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Affiliation(s)
- D N Franz
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Abstract
PURPOSE Lamotrigine (LTG), a newer antiepileptic drug (AED), has activity against both partial-onset and generalized seizures. Its reported benefits for behavior, and its effectiveness in Lennox-Gastaut syndrome and other forms of refractory epilepsy, make it a logical choice for treatment of epilepsy in tuberous sclerosis complex (TSC). We present our experience with LTG therapy of epilepsy in 57 patients with TSC. METHODS Patients fulfilled the diagnostic criteria for clinically definite TSC. LTG was initiated and increased until improvement in seizure frequency was noted, intolerable side effects occurred, or maximal doses were reached. Seizure frequency and behavioral changes were recorded during LTG therapy and compared with those prior to the introduction of LTG. RESULTS Twenty-four (42%) were seizure free, and 21 (37%) had a >50% reduction in seizure frequency. Eighteen (32%) had subjectively improved behavior and/or alertness with daily activities. Thirty-eight (67%) had no change in this regard, whereas one (2%) became worse. Responders were more likely to not have a history of infantile spasms, and to have experienced only partial seizures (p < 0.05). Otherwise no phenotypic correlations with response were apparent. CONCLUSIONS Among patients with TSC and epilepsy, LTG was effective and well tolerated, including as initial monotherapy. Improved alertness and behavior were apparent in many patients. The incidence of side effects is similar to that reported for other pediatric populations with symptomatic partial epilepsy. The usefulness of LTG in TSC may relate to an underlying defect of glutamatergic neurotransmission in partial epilepsy.
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Affiliation(s)
- D N Franz
- Department of Pediatrics, University of Cincinnati College of Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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Sethuraman G, Srinivas CR, Byravarathinam S, Raman ML, Smiles L, Rao S. Leprosy with peripheral T-cell lymphoma: a rare association. Int J Lepr Other Mycobact Dis 2001; 69:119-22. [PMID: 11757170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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Abstract
We describe an Indian man with the unusual association of classical cutaneous features of Ehlers-Danlos syndrome, a marfanoid habitus, bladder diverticula and multiple emphysematous bullae.
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Affiliation(s)
- S Handa
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Affiliation(s)
- G Sethuraman
- Departments of Dermatology and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Sharma VK, Sethuraman G, Kumar B. Cutaneous adverse drug reactions: clinical pattern and causative agents--a 6 year series from Chandigarh, India. J Postgrad Med 2001; 47:95-9. [PMID: 11832597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
AIM To study the different clinical spectrum of cutaneous adverse drug reactions (ADR) and to determine the causative drugs. MATERIALS & METHODS A prospective, hospital based study was carried out over a period of 6 years recording various cutaneous ADR. RESULTS A total of 500 patients with cutaneous ADR were enrolled in the study. The most common types of cutaneous ADR patterns were maculopapular rash (34.6%), fixed drug eruption (FDE) (30%) and urticaria (14%). The drugs most often incriminated for the various cutaneous ADR were antimicrobials (42.6%), anticonvulsants (22.2%) and NSAIDs (18%). Anticonvulsants were implicated in 41.6% of maculopapular rashes. Sulfonamides accounted for 43.3% and NSAIDs for 30.7% of FDE. Urticaria was caused mainly by NSAIDs(24.3%) and penicillins(20%). Anticonvulsants were responsible for 43.8% of life-threatening toxic epidermal necrolysis and Stevens Johnson syndrome. CONCLUSIONS The clinical pattern and drugs causing cutaneous ADR are similar to those observed in other countries except for minor variations. Cutaneous ADR patterns and the drugs causing various reactions are changing every year, which may be due to the emergence of newer molecules and changing trends in the use of drugs.
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Affiliation(s)
- V K Sharma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India.
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Abstract
The acro-osteolyses are a heterogeneous group of disorders characterized by bone resorption. The disorder may occur as familial, idiopathic, or secondary to vascular, inflammatory, or neurologic conditions. Acro-osteolysis is rare in association with spinal dysraphism. It is even rarer for it to be the presenting symptom in spinal dysraphism. We report here four patients in whom the diagnosis of spinal dysraphism was established while investigating for the various causes of acro-osteolysis. All four patients presented with trophic changes and acro-osteolysis. Hyperhidrosis in the affected limb was seen in three patients. One patient had leg pain, the others had no sensory or motor deficits. Magnetic resonance imaging showed spinal dysraphism in all four patients.
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Affiliation(s)
- G Sethuraman
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Upadhyaya HP, Brady KT, Sethuraman G, Sonne SC, Malcolm R. Venlafaxine treatment of patients with comorbid alcohol/cocaine abuse and attention-deficit/hyperactivity disorder: a pilot study. J Clin Psychopharmacol 2001; 21:116-8. [PMID: 11199938 DOI: 10.1097/00004714-200102000-00025] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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