Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study

Introduction:

Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control.

Aims and Objectives:

We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month.

Materials and Methods:

Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections.

Results:

Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3.

Limitations:

Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period.

Conclusion:

MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.

Estimating the Impact of Extragenital Warts versus Genital Warts on Quality of Life in Immunocompetent Indian Adult Patients: A Comparative Cross-Sectional Study

Background:

Extra-genital warts (EGWs) affect 7-10% of population. Even though a plethora of studies have been conducted to assess the impact of genital warts (GWs) showing a significant impact on the quality of life but surprisingly, barely any data has been collected on the impact of EGWs on quality of life.

Aims and Objective:

This cross-sectional study aimed at comparing the magnitude of EGWs on health-related quality of life and various variables with that of GWs.

Patients and Methods:

The study consisted of two groups of immunocompetent adults, each with 100 patients aged 18 years or above, attending the skin outpatient department at our tertiary center between April 2018 and March 2019 and consented to participate. Group A consisted of patients with EGWs and group B comprised of patients with GWs. All patients were asked to fulfill the validated Hindi hard copy of the Dermatology Life Quality Index (DLQI) questionnaire.

Results:

The mean DLQI score of patients with EGWs was 8.73 ± 0.84 and that of patients with GWs was 5.83 ± 0.83 (P = 0.026). In group A, those affected the most were patients with warts on multiple exposed sites (mean DLQI score of 14), followed by warts on feet (mean DLQI score of 10.69), followed by warts on hands (DLQI score of 9.12), and facial warts (DLQI score of 6.80). Patients with a prior history of failed treatment and/or a longer duration of illness had a higher level of dissatisfaction. To the best of our knowledge, no such study has been conducted in the past in our country.

Conclusions:

EGWs inflict a severe negative impact on the quality of life. Owing to its notorious persistence and recurrence, healthcare professionals must educate patients on how to prevent the spread and recurrence, discuss details of available treatment modalities while keeping in view the psychological and sociological impact.

Characterization of Event Related Potentials Using Information Theoretic Distance Measures

Analysis of event-related potentials (ERPs) using signal processing tools has become extremely widespread in recent years. Nonstationary signal processing tools such as wavelets and time-frequency distributions have proven to be especially effective in characterizing the transient phenomena encountered in event-related potentials. In this paper, we focus on the analysis of event-related potentials collected during a psychological experiment where two groups of subjects, spider phobics and snake phobics, are shown the same set of stimulus: A blank stimulus, a neutral stimulus and a spider stimulus. We introduce a new approach, based on time-frequency distributions, for analyzing the ERPs. The difference in brain activity before and after a stimulus is presented is quantified using distance measures as adapted to the time-frequency plane. Three different distance measures, including a new information theoretic distance measure, are applied on the time-frequency plane to discriminate between the responses of the two groups of subjects. The results illustrate the effectiveness of using distance measures combined with time-frequency distributions in differentiating between the two classes of subjects and the different regions of the brain.

Human hair colonizing fungi in water sediments of India

Out of 144 samples of water sediments, 183 isolates belonging to 9 genera and 22 species were isolated. Fifty-nine isolates of Acremonium, 26 of Chrysosporium indicum, 22 of Chrysosporium keratinophilum, 17 of Malbranchea sp. and 10 of Microsporum gypseum were recovered. Acremonium implicatum, Chrysosporium georgii, Chrysosporium xerophilum and Geomyces pannorum were reported for the first time from India.

Quality estimation of subdurally recorded, event-related potentials based on signal-to-noise ratio

Our goal is to develop a direct brain interface (DBI) that will provide communication and environmental control to persons who are "locked-in" (or nearly so) as a consequence of brainstem stroke, amyotrophic lateral sclerosis (ALS), or other etiologies. Previously we demonstrated that templates constructed from trigger averaged event-related potentials (ERPs) can be cross-correlated with ongoing electrocorticograms (ECoGs) to detect ERPs associated with the performance of simple motor actions. However, it was difficult to predict a priori which of many candidate ECoG recording site(s) could provide signals that would provide adequate motor action detection. We present here a measure of ERP quality based on an estimate of the signal to noise ratio (SNR) associated with the formation of an ERP template from the performance of consecutive voluntary actions. Detection-theory-based receiver operator characteristics (ROCs) and a database of ECoGs (6000+) recorded from the cortical surface of awake human subjects were used to assess the usefulness of the SNR technique. The SNR method was found to predict the detection efficacy of ERPs when characterized over a wide parameter range, with the majority of ROC curve areas greater than 90%. This method was compared with our previously developed quality measure (the peak-to-baseline ratio) and found to provide significantly better performance (ROC area differences from 4.4% to 13.7%). Thus, the SNR estimate of the ERP is a useful tool to predict the efficacy of ERP templates for cross-correlation-based detection and assist in the selection of viable ERP templates for DBI applications.

A direct brain interface based on event-related potentials

Cross-correlation between a trigger-averaged event-related potential (ERP) template and continuous electrocorticogram was used to detect movement-related ERP's. The accuracy of ERP detection for the five best subjects (of 17 studied), had hit percentages >90% and false positive percentages <10%. These cases were considered appropriate for operation of a direct brain interface.

Identification of electrocorticogram patterns as the basis for a direct brain interface

This study reports on the first step in the development of a direct brain interface based on the identification of event-related potentials (ERPs) from an electrocorticogram obtained from the surface of the cortex. Ten epilepsy surgery patients, undergoing monitoring with subdural electrode strips and grid arrays, participated in this study. Electrocorticograms were continuously recorded while subjects performed multiple repetitions for each of several motor actions. ERP templates were identified from action-triggered electrocorticogram averages using an amplitude criterion. At least one ERP template was identified for all 10 subjects and in 56% of all electrode-recording sets resulting from a subject performing an action. These results were obtained with electrodes placed solely for clinical purposes and not for research needs. Eighty-two percent of the identified ERPs began before the trigger, indicating the presence of premovement ERP components. The regions yielding the highest probability of valid ERP identification were the sensorimotor cortex (precentral and postcentral gyri) and anterior frontal lobe, although a number were recorded from other areas as well. The recording locations for multiple ERPs arising from the performance of a specific action were usually found on close-by electrodes. ERPs associated with different actions were occasionally identified from the same recording site but often had noticeably different characteristics. The results of this study support the use of ERPs recorded from the cortical surface as a basis for a direct brain interface.

Detection of event-related potentials for development of a direct brain interface

The study presented here is part of an ongoing effort to develop a direct brain interface based on detection of event-related potentials (ERPs). In a study presented in a companion article, averaged ERP templates were identified from electrocorticograms recorded during repetition of voluntary motor actions. Here the authors report on the detection of individual motor ERPs within the electrocorticogram using cross-correlation. An averaged ERP template was created from the first half of each electrocorticogram and then cross-correlated with the continuous electrocorticogram from the second half. Points where the cross-correlation value exceeded an experimentally determined detection threshold were considered to be detection points. A detection point was considered to be a valid "hit" if it occurred between 1 second before and 0.25 second after the recorded time of a voluntary action. The difference between the hit and false-positive percentages (HF-difference) was used as a metric of detection accuracy. HF-differences greater than 90 were found for 5 of 15 subjects, HF-differences greater than 75 were found for 8 of 15 subjects, and HF-differences greater than 50 were found for 12 of 15 subjects. The three other subjects with HF-differences less than 50 had electrode locations not well suited for recording movement-related ERPs. Recordings from sensorimotor and supplementary motor areas produced the highest yield of channels with HF-difference greater than 50; however, a number of channels with good performance were found in other areas as well. The results demonstrate the likely prospect of using ERP detection as the basis of a single-switch direct brain interface and that furthermore, there is a good possibility of obtaining multiple control channels using this approach.

An information flow technique for category related evoked potentials

We report a technique for studying interactions among many subsystems of a biological system. A general mathematical technique is developed for information flow among various subsystems of a system when two or more classes of stimuli are presented to the system. The technique is validated by various simulation studies and then applied to a brain system. The usefulness of the technique is demonstrated for visual event related potentials (ERP's) obtained from human subjects suffering from phobias. The stimuli are briefly flashed words and phrases. The word classes are pleasant, unpleasant, conscious, and unconscious. The conscious class consists of words known by the patient to relate to the problem, whereas the unconscious class of words consists of words related to deep conflicts which are not recognized by the patient. It is demonstrated that information flow is suppressed under supraliminal presentation of the unconscious class, but is strong under subliminal presentation. The technique has the potential of being an objective indicator of conflictual relationships in these patients. The principle of the technique can be applied to any system in which interactions among subsystems are to be analyzed.

Occurrence of keratinophilic fungi on Indian birds

Keratinophilic fungi were isolated from feathers of most common Indian birds, viz. domestic chicken (Gallus domesticus), domestic pigeon (Columba livia), house sparrow (Passer domesticus), house crow (Corvus splendens), duck (Anas sp.), rose-ringed parakeet (Psittacula krameri). Out of 87 birds, 58 yielded 4 keratinophilic fungal genera representing 13 fungal species and one sterile mycelium. The isolated fungi were cultured on Sabouraud's dextrose agar at 28 +/- 2 degrees C. Chrysosporium species were isolated on most of the birds. Chrysosporium lucknowense and Chrysosporium tropicum were the most common fungal species associated with these Indian birds. Maximum occurrence of fungi (47%) was recorded on domestic chickens and the least number of keratinophilic fungi was isolated from the domestic pigeon and duck. The average number of fungi per bird was found to be the 0.44.

In vitro activity of certain antibiotics against dermatophytes

The in vitro effect of antibiotics i.e. Hamycin, Griseofulvin and Mycostatin against Microsporum gypseum and M. fulvum showed that hamycin was comparatively less inhibitory to M. fulvum. Complete inhibition in mycelial growth and sporulation of these two dermatophytes was observed by Mycostatin at its 1000 micrograms/ml conc. after 8 days. M. fulvum did not sporulate at higher concentration of griseofulvin. However, griseofulvin completely inhibited the sporulation in M. gypseum at all the concentration of this drug, but mycelial growth of M. fulvum and M. gypseum were significantly inhibited. Mycostatin was found more inhibitory to these dermatophytes in comparison to hamycin and griseofulvin.

Hair perforation by keratinophilic fungi

The in vitro hair perforation test as described by Ajello and George, was applied to eight species of Chrysosporium and one species each of Microsporum and Trichophyton. Six of them were found to perforate hair while four were negative. Chr. keratinophilum, M. gypseum and Tr. vanbreuseghemii were able to perforate and degrade hair rapidly. The micromorphological changes were also described.