Efficacy and Safety Comparison of Basic Fibroblast Growth Factor-Related Decapeptide 0.1% Solution (bFGFrP) Plus Oral PUVA Combination Therapy with Oral PUVA Monotherapy in the Treatment of Vitiligo

Background

Phototherapy in its different forms, is mainstay of vitiligo management. Combining treatment modalities like topical calcipotriol (for quicker, more intense repigmentation), Low dose azathioprine with PUVA have proven to be beneficial in management of vitiligo due to different mechanisms of repigmentation and their synergistic effects. Topical bFGF-related decapeptide (bFGFrP) application followed by sun exposure/ UVA phototherapy yields effective repigmentation. bFGFrP has shown to aid the targeted phototherapy in smaller lesions and its combinations with other treatment modalities have been very promising. However, there is paucity of studies on combination treatments; especially oral PUVA along with bFGFrP. This study was aimed at evaluating safety and efficacy of combination of bFGFrP with Oral PUVA in vitiligo (larger body surface area 20% or more).

Materials and Methods

Phase IV, randomized, multicentre study (N = 120) in adult patients with stable vitiligo of 6 months treatment period with monthly follow up visits. Psoralen (Tab. Melanocyl) dosage 0.6 mg/kg orally 2 h before exposure to UVA phototherapy. Oral PUVA therapy, initially, at an irradiation dose 4 J/cm2 (PUVA group), followed by increments 0.5 J/cm2 every four sittings if tolerated for twice weekly. Primary end point was improvement in extent of repigmentation (EOR) in target lesion (at least 2 cm × 2 cm in greatest dimension, without leukotrichia), while secondary endpoints were improvement in patient global assessment (PGA) and safety at end of 6 months of treatment period in bFGFrP + oral PUVA combination group and Oral PUVA monotherapy group.

Results

End of 6 months, significantly greater EOR >50%) was achieved in 61.8% (34 patients, n = 55) from combination group while 30.2% (16 patients, n = 53) from the oral PUVA monotherapy group (n = 53). Regarding Grade of repigmentation (GOR), complete repigmentation was observed 5.5% (3 patients, n = 55) in combination group whereas no patient showed complete repigmentation in monotherapy group (p ≤ 0.05), PGA showed significant overall improvement in combination group (p ≤ 0.05); 6 patients (10.9%) from combination group Vs one (1.9%) showed complete improvement. During treatment period, there were no reported adverse events.

Conclusions

Addition of bFGFrP to oral PUVA therapy resulted in intense and faster induction of repigmentation than oral PUVA monotherapy with favorable safety profile.

Clinico-Epidemiology and Histopathologic Spectrum of Primary Scarring Alopecia: A Cross-Sectional Study

Background

Primary scarring alopecias (PSAs) are a rare group of dermatological disorders with overlapping clinical features. They result in permanent hair loss and significant psychological morbidity.

Aims

To analyze the clinico-epidemiology of PSAs of the scalp, along with clinico-pathological correlation.

Methods

We conducted a cross sectional, observational study including 53 histopathologically confirmed cases of PSA. Clinico-demographic parameters, hair care practices, and histologic characteristics were noted and statistically analyzed.

Results

Among 53 patients (mean age 30.9 ± 8.1 years, M: F 1:1.2, median duration 4 years) with PSA, lichen planopilaris (LPP) was most common (39.6%, 21/53), followed by pseudopelade of Brocq [30.2%, 16/53], discoid lupus erythematosus (DLE) [16.9%, 9/53], and non-specific scarring alopecia (SA) (7.5%, 4/53), while central centrifugal cicatricial alopecia (CCCA), folliculitis decalvans, and acne keloidalis nuchae (AKN) accounted for 1 case each. Forty-seven patients (88.7%) demonstrated predominant lymphocytic inflammatory infiltrate, while basal cell degeneration and follicular plugging were the commonest histological changes. Perifollicular erythema and dermal mucin deposition were noted in all patients with DLE (both P < 0.05). Nail involvement (P = 0.004) and mucosal involvement (P = 0.8) were more common in LPP. Single alopecic patches were characteristic of DLE and CCCA. Hair care practices (non-medicated shampoo > oil) had no significant association with the subtype of PSA. (P = 0.4).

Conclusion

PSAs are a diagnostic challenge for dermatologists. Thus, histology and clinico-pathological correlation should be performed in all cases for proper diagnosis and treatment.

Fugitive dust emission control study for a developed smart dry fog system

Air pollution due to dust emission is continuously increasing day by day in mining and allied industrial areas. Mining operations contribute a substantial amount of dust emission at the crushing, screening, and bulk material handling in loading areas. The ambient suspended dust particles create a severe nuisance to workers and local dwellers. For effective controlling of positive dust emission, an innovative automated dry fog dust suppression system (DFDSS) has been developed using hybrid nozzles, sensors, actuators, controllers, screw compressors, air receivers, pumps, motors, and water arrangement with filtration facility. The DFDSS was installed in a crushing and screening plant of an iron ore mine in India. Performance study indicted fugitive dust emission concentration values ranged from 354 to 7040 μg m^-3, which was reduced to 91-300 μg m^-3 after installation of DFDSS. The reduced values were within the permissible limit of 1200 μg m^-3 at a distance of 25 ± 2 m in the predominant downwind direction. The installed DFDSS added a meager addition of moisture content of 0.032% in the handling iron ore material, which was below the acceptable limit of 0.1%. The DFDSS precisely regulated fugitive dust emission from various mining activities without affecting the minerals processing performance. Thus, the DFDSS can be implemented effectively in different mining and allied industries where there is a dust emission problem.

Impact of prebiotics on immune response: from the bench to the clinic

Several preclinical and clinical studies have shown the immunomodulatory role exerted by prebiotics in regulating the immune response. In this review, we describe the mechanistic and clinical studies that decipher the cell signaling pathways implicated in the process. Prebiotic fibers are conventionally known to serve as substrate for probiotic commensal bacteria that release of short-chain fatty acids in the intestinal tract along with several other metabolites. Subsequently, they then act on the local as well as the systemic immune cells and the gut-associated epithelial cells, primarily through G-protein-coupled receptor-mediated pathways. However, other pathways including histone deacetylase inhibition and inflammasome pathway have also been implicated in regulating the immunomodulatory effect. The prebiotics can also induce a microbiota-independent effect by directly acting on the gut-associated epithelial and innate immune cells through the Toll-like receptors. The cumulative effect results in the maintenance of the epithelial barrier integrity and modulation of innate immunity through secretion of pro- and anti-inflammatory cytokines, switches in macrophage polarization and function, neutrophil recruitment and migration, dendritic cell and regulatory T-cell differentiation. Extending these in vitro and ex vivo observations, some prebiotics have been well investigated, with successful human and animal trials demonstrating the association between gut microbes and immunity biomarkers leading to improvement in health endpoints across populations. This review discusses scientific insights into the association between prebiotics, innate immunity and gut microbiome from in vitro to human oral intervention.

Baseline factors associated with early and late death in intracerebral haemorrhage survivors

Background and purpose

The aim of this study was to determine whether early and late death are associated with different baseline factors in intracerebral haemorrhage (ICH) survivors.

Methods

This was a secondary analysis of the multicentre prospective observational CROMIS‐2 ICH study. Death was defined as ‘early’ if occurring within 6 months of study entry and ‘late’ if occurring after this time point.

Results

In our cohort (n = 1094), there were 306 deaths (per 100 patient‐years: absolute event rate, 11.7; 95% confidence intervals, 10.5–13.1); 156 were ‘early’ and 150 ‘late’. In multivariable analyses, early death was independently associated with age [per year increase; hazard ratio (HR), 1.05, P = 0.003], history of hypertension (HR, 1.89, P = 0.038), pre‐event modified Rankin scale score (per point increase; HR, 1.41, P < 0.0001), admission National Institutes of Health Stroke Scale score (per point increase; HR, 1.11, P < 0.0001) and haemorrhage volume >60 mL (HR, 4.08, P < 0.0001). Late death showed independent associations with age (per year increase; HR, 1.04, P = 0.003), pre‐event modified Rankin scale score (per point increase; HR, 1.42, P = 0.001), prior anticoagulant use (HR, 2.13, P = 0.028) and the presence of intraventricular extension (HR, 1.73, P = 0.033) in multivariable analyses. In further analyses where time was treated as continuous (rather than dichotomized), the HR of previous cerebral ischaemic events increased with time, whereas HRs for Glasgow Coma Scale score, National Institutes of Health Stroke Scale score and ICH volume decreased over time.

Conclusions

We provide new evidence that not all baseline factors associated with early mortality after ICH are associated with mortality after 6 months and that the effects of baseline variables change over time. Our findings could help design better prognostic scores for later death after ICH.

Risks associated with oral deferiprone in the treatment of infratentorial superficial siderosis

Objective

Deferiprone is an iron chelator that has recently been used to treat patients with infratentorial superficial siderosis (iSS). It is considered to have a generally favourable safety profile but concerns have been raised due to the risk of agranulocytosis. We aimed to evaluate the safety and tolerability of oral deferiprone as a treatment for patients with iSS.

Methods

We present a case series of 10 consecutive patients presenting with classical iSS treated with deferiprone.

Results

Ten patients were followed up for a mean period of 2.3 years (range 0.5–5.5 years). Four patients (40%) were withdrawn from treatment because of treatment-related side effects. The reasons for treatment discontinuation were neutropenic sepsis (n = 3) and fatigue (n = 1). In 2 out of the 3 cases of neutropenic sepsis, patients initially developed neutropenia without sepsis. The mean time to neutropenic sepsis following deferiprone was 1.2 years (range 0.3–2.5) with mean neutrophil count of 0.4 (range 0.3–0.5). Six patients (60%) reported no change in neurological function while on treatment, and four patients (40%) reported that their condition deteriorated.

Conclusions

Deferiprone was poorly tolerated, with 40% of patients withdrawing from treatment, most commonly due to neutropenic sepsis, after an average of 2 years on treatment. This study increases the number of reported cases of agranulocytosis in patients with iSS treated with deferiprone. Clinicians treating iSS patients with deferiprone should be aware that this drug has a potentially life-threatening side effect of neutropenic sepsis, and should ensure that appropriate haematological monitoring is in place.

Circulatory miR-98-5p levels are deregulated during diabetes and it inhibits proliferation and promotes apoptosis by targeting PPP1R15B in keratinocytes

Although deregulated circulatory miRNA signatures during diabetes have been identified for some years now, the effects of such miRNAs on several target tissues are not yet thoroughly investigated. The skin that is nourished by components present in the circulation exhibits several notable abnormal features during diabetes. We, therefore, hypothesized that such altered circulatory miRNA levels might be critical in the onset and progression of impaired skin health during diabetes. RNA sequencing from blood samples of normal and type 2 diabetic human subjects identified 9 upregulated and 19 downregulated miRNAs. miR-98-5p was significantly downregulated and its overexpression down-regulated PPP1R15B levels in HaCaT cells and this was prevented by the miR-98-5p inhibitor. This was validated in human primary epidermal keratinocytes and further supported by a dual reporter luciferase assay of the PPP1R15B 3'UTR where miR-98-5p significantly decreased the luciferase activity which was prevented in the presence of the miRNA inhibitor and by mutation in the miRNA binding site. By targeting PPP1R15B, miR-98-5p increases levels of p-eIF2α, BiP and CHOP. Consequently, there was induction of apoptosis accompanied with decreased proliferation in the presence of miR-98-5p. Conversely, miR-98-5p inhibition alone inhibited apoptosis and promoted proliferation. Taken together, our data suggest that by targeting PPP1R15B, miR-98-5p induces apoptosis and decreases proliferation. As opposed to this since circulatory miR-98-5p levels are decreased in diabetes, we believe that this decrease in the circulation that feeds the skin layers might be a major contributor of hyperproliferation as seen in the skin during diabetes.Abbreviations: miRNAs: MicroRNAs; PPP1R15B: PPP1R15B: Protein Phosphatase 1 Regulatory Subunit 15B; TGFβR1: Transforming Growth Factor Beta Receptor 1; ER: Endoplasmic Reticulum; Bip: Binding Immunoglobulin Protein; Chop: CCAAT-enhancer-binding protein homologous protein; p-eIF2α: Eukaryotic Translation Initiation Factor 2a; Bax: Bcl2-associated X protein; Bcl-2: B-cell CLL/lymphoma 2; PCNA: Proliferating Cell Nuclear Antigen; K5: Cytokeratin 5; qRT-PCR: Quantitative Real-Time PCR; ESCC: Oesophageal squamous cell carcinoma; HCC: Hepatocellular carcinoma; CTHRC1: Collagen triple helix repeat containing 1; SALL4: Sal-like protein 4; TNFα: Tumour Necrosis Factor alpha; PGC-1β: Peroxisome Profilerator-activated receptor-γ coactivator-1β; IGF2BP1: Insulin-like growth factor 2 mRNA binding protein 1.

Bacteriological Profile of Aerobic and Anaerobic Isolates of Trophic Ulcer in Leprosy: A Study from Eastern India

Introduction

Trophic ulcer is a dreaded complication of leprosy. Secondary infection compounds the damage to the already neglected ulcer.

Aims

To find out the bacterial pathogens in the isolates from trophic ulcers of leprosy and to find the drug sensitivity of the aerobic isolates so as to start a suitable antibiotic therapy.

Methodology

An institution-based, cross-sectional study done over a period of 2 years. Swab was taken from the deeper part of the ulcer. It was put on a suitable culture media. Bacteriological profile was determined and antibiogram was done subsequently.

Results

Sixty patients with trophic ulcer secondary to leprosy were screened, among which all were screened for aerobic isolates and 38 were screened for anaerobic isolates. Among the aerobic isolates, 88% of patients were culture-positive. The most common organism was Staphylococcus aureus (37.7%), followed by Pseudomonas aeruginosa (22.64%), Proteus mirabilis (15.09%), Escherischia coli (13.2%), Klebsiella (9.43%). Maximum overall sensitivity was seen with amikacin (93.1%) and linezolid (89.65%). Maximum overall resistance was noted with cotrimoxazole (58.62%) and coamoxiclav (51.72%). Among the 38 patients cultured for anaerobic isolates, 17 were culture-positive for anaerobic organisms. Isolates showing Peptococcus were 6 (15.7%), purely Peptostreptococcus were 4 (10.5%), purely bacteroides were 3 (7.8%), and mixed growths were 4 (10.5%).

Conclusion

Secondary bacterial infection is quite common in leprosy trophic ulcers. The most common organism was Staphylococcus aureus. Isolates were mostly sensitive to amikacin and linezolid and resistant to cotrimoxazole and coamoxiclav. Anaerobic isolates were not uncommon, with Peptococcus being the most common among them.

The Bumpy Face of Che Guevara: An Interesting Case

Placement of decorative tattoo on the skin may lead to various immunological, infective, and coincidental complications. Inoculation of human papillomavirus leading to development of verruca is an uncommon complication of tattoos. The present report highlights the development of verruca vulgaris, developing after 2 years of tattooing in a young male.

Convexity subarachnoid haemorrhage has a high risk of intracerebral haemorrhage in suspected cerebral amyloid angiopathy

The risk of future symptomatic intracerebral haemorrhage (sICH) remains uncertain in patients with acute convexity subarachnoid haemorrhage (cSAH) associated with suspected cerebral amyloid angiopathy (CAA). We assessed the risk of future sICH in patients presenting to our comprehensive stroke service with acute non-traumatic cSAH due to suspected CAA, between 2011 and 2016. We conducted a systematic search and pooled analysis including our cohort and other published studies including similar cohorts. Our hospital cohort included 20 patients (mean age 69 years; 60% male); 12 (60%) had probable CAA, and 6 (30%) had possible CAA according to the modified Boston criteria; two did not meet CAA criteria because of age <55 years, but were judged likely to be due to CAA. Fourteen patients (70%) had cortical superficial siderosis; 12 (60%) had cerebral microbleeds. Over a mean follow-up period of 19 months, 2 patients (9%) suffered sICH, both with probable CAA (annual sICH risk for probable CAA 8%). In a pooled analysis including our cohort and eight other studies (n = 172), the overall sICH rate per patient-year was 16% (95% CI 11–24%). In those with probable CAA (n = 104), the sICH rate per patient-year was 19% (95% CI 13–27%), compared to 7% (95% CI 3–15%) for those without probable CAA (n = 72). Patients with acute cSAH associated with suspected CAA are at high risk of future sICH (16% per patient-year); probable CAA might carry the highest risk.

Molecular diversity in several pyridyl based Cu(ii) complexes: biophysical interaction and redox triggered fluorescence switch

A novel approach for detection of intra-cellular Cu⁺inE. coliand human blood cells is reported. Studies on several pyridyl based Cu(ii) complexes and interaction of ct DNA with one of them are carried out for plausible application in biology concerning disruption of normal DNA activity.

Micro RNA: an epigenetic regulator of type 2 diabetes

Type 2 Diabetes is a complex disease with multifactorial pathogenesis. The interplay between genes and lifestyle changes complicates the etiology of the disease. In spite of growing number of attempts to unravel the mechanism of this metabolic disease, the molecular nature of type 2 Diabetes is not fully understood. The discovery of a new class of non-coding RNAs, micro RNAs and their role in regulation of gene expression have paved the way for better understanding of disease pathogenesis. Increasing number of evidences suggest crucial role of miRNAs in insulin resistance and β cell dysfunction, which are the two main features of type 2 Diabetes. This review summarizes the role of miRNA in elicitation and progression of type 2 Diabetes.

Type 2 diabetes and gut microbiome: at the intersection of known and unknown

The prevalence of metabolic syndrome is increasing rapidly across the globe. Though the prevalence of the disease is similar in population of upper middle income and high income countries, the age of affected population is lower in upper middle income countries. This is attributed to genetic as well as changing life style factors. The contributing factors for type 2 diabetes range from genetic/epigenetic disposal, intra uterine nutrition, dietary pattern to sedentary lifestyle. The role of the gut microbiota in metabolic disorders is increasingly gaining importance. Several studies have reported significant difference in the profile of the gut microbiota in Caucasian population considering obese and type 2 diabetic populations while limited number of studies are available on populations from the developing world. The metabolites from the gut microbes contribute to the gut barrier integrity and a compromised barrier leads to leakage of inflammatory mediators into systemic circulation and hence increases insulin resistance. Attempts have been made at correcting metabolic syndrome through dietary changes by altering the gut microbiota with some success. This report is an attempt to explain the hypothesis of compromised nutrition altering the gut microbiota, gut metabolites, gut barrier function, systemic inflammation and hence insulin response.

Azithromycin-induced rash in a patient of infectious mononucleosis - a case report with review of literature

Antibiotic induced skin rash in setting of infectious mononucleosis is often encountered in clinical practice. However, macrolides like azithromycin are considered relatively safe and till date only two cases of azithromycin induced rash in setting of infectious mononucleosis have been reported. The following report illustrates the case of a 23-year-old man suffering from infectious mononucleosis who exhibited a generalized cutaneous rash following treatment with azithromycin. Using the Naranjo ADR probability scale, this case of acute onset rash following azithromycin administration was found to be in 'probable' category. The mechanism of antibiotic-induced rash in patients suffering from infectious mononucleosis is incompletely understood. It has been suggested that the rash could result from virus mediated immunomodulation or due to altered drug metabolism. The report calls for cautious use of antibiotics in the setting of suspected viral infections like infectious mononucleosis as injudicious use might increase the risk of deleterious skin reactions and increase the cost of healthcare.

Characterization of two homogalacturonan pectins with immunomodulatory activity from green tea

Two natural homogalacturonan (HG) pectins (MW ca. 20 kDa) were isolated from green tea based on their immunomodulatory activity. The crude tea polysaccharides (TPS1 and TPS2) were obtained from green tea leaves by hot water extraction and followed by 40% and 70% ethanol precipitation, respectively. Two homogenous water soluble polysaccharides (TPS1-2a and TPS1-2b) were obtained from TPS1 after purification with gel permeation, which gave a higher phagocytic effect than TPS2. A combination of composition, methylation and configuration analyses, as well as NMR (nuclear magnetic resonance) spectroscopy revealed that TPS1-2a and TPS1-2b were homogalacturonan (HG) pectins consisting of a backbone of 1,4-linked α-D-galacturonic acid (GalA) residues with 28.4% and 26.1% of carboxyl groups as methyl ester, respectively. The immunological assay results demonstrated that TPS1-2, which consisted mainly of HG pectins, showed phagocytosis-enhancing activity in HL-60 cells.

Characterisation and identification of enzyme-producing autochthonous bacteria from the gastrointestinal tract of two Indian air-breathing fish

Characterisation and identification of autochthonous enzyme-producing bacteria isolated from the proximal intestine and distal intestine of two species of Indian air-breathing fish, murrel (Channa punctatus) and stinging catfish (Heteropneustes fossilis), were investigated using conventional culture technique. Population levels of proteolytic strains were highest in the digestive tract of stinging catfish. In both species, the viable counts of amylase-producing bacteria were somewhat higher than cellulase-producing bacteria. Among the gut bacteria isolated, 8 strains (4 from murrel and 4 from stinging catfish) were selected as potent enzyme-producers on the basis of quantitative enzyme assays. All these strains were Gram-positive rods, but only four isolates (CPF4, CPH6, CPH7 and HFH4) were capable of forming endospores. The tested bacteria grew in wide range of temperatures and pH. The strains were further identified by 16S rRNA gene sequence analysis. Two strains, CPF3 (isolated from murrel) and HFH4 (isolated from stinging catfish) showed high similarity to Bacillus sp., strain HFH7 (isolated from the stinging catfish) was most closely related to Bacillus subtilis, while five strains belonged to Bacillus licheniformis. Based on the results of the present study, we suggest that incorporation of autochthonous enzyme-producing bacteria in aquafeeds merits further investigations.

Fungal rhinosinusitis: a prospective study in a University hospital of Uttar Pradesh

BACKGROUND

To assess the purpose of fungal rhinosinusitis in a University hospital and to correlate histopathological findings with culture results for accurate clinical classification of the disease.

MATERIALS AND METHODS

One-hundred suspected patients were included in the study. Data was collected in a brief predetermined format. Samples like nasal lavages, sinus secretions, and tissue specimens were processed and examined by microbiology culture using recommended techniques. Slide culture was done to observe the microscopic morphology. Histopathological examination was done by H and E stain and PAS stain for classification.

RESULTS

Out of 100 cases of rhinosinusitis, 21 cases were culture-positive for fungal rhinosinusitis. On the basis of histopathological findings, 14 cases (66.67%) were found to be of non-invasive fungal rhinosinusitis. Aspergillus flavus was the most common fungal isolate.

CONCLUSION

Mycological profile of rhinosinusitis in Lucknow was thus evaluated. Histopathological and microbiological findings reported 21 cases of fungal rhinosinusitis among 100 suspected cases of rhinosinusitis.

Adiponectin and IL-6: Mediators of inflammation in progression of healthy to type 2 diabetes in Indian population

Aim The objective of the study was to identify the association if any, of inflammatory markers (adiponectin and IL-6) with fasting glucose in normoglycemic (healthy), prediabetic (impaired fasting glucose), and hyperglycemic (diabetic) people in Indian population. Methods Total 162 volunteers were distributed into 3 groups (normoglycemic, individuals with impaired fasting glucose, and hyperglycemic) as per ADA criterion. The blood chemistry parameters were analyzed and serum adiponectin and IL-6 levels were measured by ELISA. Results Significant reduction was observed in serum adiponectin level in hyperglycemic and impaired fasting glucose population compared with normoglycemic population. Significant reduction in adiponectin was also observed in impaired fasting glucose group compared with hyperglycemic group. Similarly significant increase was also observed in IL-6 level in hyperglycemic and impaired fasting glucose groups compared with normoglycemic group. Conclusions From our data it can be summarized that there is a significant change in both adiponectin (reduction) and IL-6 (increase) levels in normoglycemic (healthy), prediabetic (impaired fasting glucose), and hyperglycemic (diabetic) population in Indian population. There is a significant but gradual change during the progression of healthy toward diabetic population via pre-diabetic condition.

Differential regulation of free radicals (reactive oxygen and nitrogen species) by contact allergens and irritants in human keratinocyte cell line

Immune responses to chemicals resulting in sensitization and the appearance of allergic responses following subsequent exposures are dependent upon activation of T lymphocytes. On the contrary, irritant responses are independent of immune response. The aim of this project was to identify the differential signaling cascade operated in allergic and irritant contact dermatitis. Recently, we have shown that keratinocyte cell line A431 can function as an antigen presenting cell (APC) and hence can be used as a model to differentiate between an allergen and irritant molecule. Allergen- and irritant-induced regulation of reactive oxygen species (ROS) and nitric oxide (NO) has been explored. Irritants induce release of ROS even at noncytotoxic concentration. ROS generation by allergens was not detected at nontoxic concentration but as the concentration was increased to a toxic dose there was a drastic increase in the ROS level compared to the untreated cells. Hence, the regulation of ROS is not significant in allergic responses but important in irritant responses. The major difference exists in the fact that the source of ROS for irritants is mitochondria, while that of allergens is mostly cytosolic. Antioxidant-induced protection from irritant-induced cell death has also been demonstrated. NO level was found to increase by allergens and irritants in a concentration-dependent manner. Hence, the regulation of ROS and NO can be used as important mediators in contact allergic and irritant dermatitis.

Cutaneous drug hypersensitivity: immunological and genetic perspective

Drug hypersensitivity is an unpredictable, immunologically mediated adverse reaction, clustered in a genetically predisposed individual. The role of "hapten concept" in immune sensitization has recently been contested by the "pharmacological interaction" hypothesis. After completion of the "human genome project" and with the availability of high-resolution genotyping, genetic susceptibility to hypersensitivity for certain drugs has been proved beyond doubt though the trend is ethnicity and phenotype dependent. Application of this newly acquired knowledge may reduce or abolish the morbidity and mortality associated with cutaneous drug hypersensitivity.

Comparative assessment of topical steroids, topical tretenoin (0.05%) and dithranol paste in alopecia areata

BACKGROUND

There have been various controversial reports regarding the efficacy of topical agents in topical therapy of alopecia areata.

AIM

The study aims to find out the effective ones among the readily available ones for a dermatologist.

MATERIALS AND METHODS

Eighty patients were chosen from the skin OPD of Bankura Sammilani Medical College, Bankura, West Bengal, after evaluating the exclusion criterions. Treatments were continued for 3 month period and a follow up after further 3 months. After dividing them into four groups-group-I (topical steroids), group-II (topical tretinoin 0.05%) group-III (dithranol paste 0.25%), and group-IV (white soft petrolatum jelly)-patients were evaluated.

RESULTS

Seventy percent of group-I, 55% of group-II, 35% of group-III, and 20% of the control group (white soft petrolatum jelly) responded favorably. Side effects in the form of dermatitis and hyperpigmentation were seen in group-III. However, no patient discontinued from the study.

CONCLUSION

We conclude that both topical steroids and tretinoin were fairly effective in limited variant of alopecia areata.

Cloning and identification of EDD gene from ultraviolet-irradiated HaCaT cells

Ultraviolet (UV) radiation is one of the most important external stimuli that affects skin by inducing cancer, inflammation and cell death. To identify the regulation of genes regulated by UV during transformation, normal human keratinocyte cell line, HaCaT, was exposed to multiple doses of UVA+B (UVA - 150-200 mJ/cm2 and UVB - 15-20 mJ/cm2 x 6). Malignant transformation was confirmed by formation of colonies on soft agar and DNA methylation assay. To identify the genes involved in this process, random amplification of polymorphic DNA using RNA from unexposed and multiple exposed cells was performed after each exposure. A few up-regulated genes were identified, cloned and sequenced. One of the genes had homology to EDD (E3 identified by differential display) that was up-regulated at second exposure but was down-regulated in colony-forming cells (cells that received six or more exposures) as determined by RT-PCR. This is a progesterone-induced gene and progesterone treatment reduced the extent of colony formation on soft agar plate. It is possible that hormone therapy may have some effects on skin cancer in vivo.

Ultraviolet-induced transformation of keratinocytes: possible involvement of long interspersed element-1 reverse transcriptase

The normal human keratinocyte cell line, HaCaT, was transformed using multiple doses of ultraviolet (UV)A+B (UVA, 150-200 mJ/cm(2) and UVB, 15-20 mJ/cm(2) x 6). Malignant transformation was confirmed by upregulation of Cyclin D1 (mRNA) and formation of colonies on soft agar. To identify the genes involved in this transformation process, we have done rapid amplification of polymorphic DNA using RNA from unexposed and multiple-exposed cells. Six percent PAGE showed several differentially regulated genes in exposed cells compared with unexposed cells. Total 19 genes were identified, cloned and sequenced. Three of these 19 cloned genes showed 99% homology at both DNA and protein levels to a stretch of 540 bp (180 aa) of long interspersed element (LINE)-1 reverse transcriptase (RT) open reading frame (ORF-2). Colonies from soft agar showed upregulation of this gene compared with non-colonized (lawn on soft agar) cells as detected by RT-PCR. This data implicates LINE-1 RT (ORF-2) in UV-induced malignancy and can possibly be used as a marker for the diagnosis of UV-induced skin cancer.

UV induced bystander signaling leading to apoptosis

Human keratinocytes (HaCaT) were exposed to UV (A+B) (UVA-350-400 mJ/cm2 and UVB-30 mJ/cm2) which induces apoptosis as evidenced by MTT assay, DNA laddering, Bax and Fas up-regulation. UV induced apoptotic conditioned media (6 h or earlier) did not cause apoptosis in unexposed cells. However, treatment with conditioned medium collected post UV exposure (1 h) induced Bax in unexposed cells as observed by RT-PCR. The induction of cell death was initiated by conditioned medium collected 12 h after UV exposure and the extent of death was increased progressively when conditioned medium collected 24 or 72 h post UV exposure was used. Medium collected 24 h after UV exposure also increased mitochondrial membrane permeability as determined by rhodamine uptake. Conditioned medium induced apoptosis did not involve reactive oxygen species (ROS) unlike UV induced apoptosis indicating that the apoptosis pathway could be different. Interestingly, at high dilution apototic conditioned medium did not induce apoptosis but actually protected cells from UV insult. The role of nerve growth factor (NGF) in UV induced bystander effects are also discussed.

Role of Keratinocytes in Antigen Presentation and Polarization of Human T Lymphocytes

Allergic contact dermatitis is a T-cell-mediated inflammatory skin disease in which interaction between skin keratinocytes and migrating T lymphocytes may play a critical part. In this study, the role of keratinocytes as allergen-/antigen-presenting cells (APCs) leading to activation of T lymphocytes is investigated using a human epidermal cell line A431. It is known that cultured cells do not express human leucocyte antigen (HLA) and hence can be used as APCs independent of HLA profile of both APCs and T cells from human volunteers. This cell line responded to common allergens and irritants by inducing or upregulating the cell-surface expression of HLA-DR, and intercellular adhesion molecule-1 and B7 mRNA transcripts in keratinocytes. In addition, allergen-primed A431 cells also induced allergen-specific proliferation of human T lymphocytes in cocultures. Anti-HLA-DR, interleukin-1alpha (IL-1alpha) antibodies and lysosomotropic agent chloroquine inhibited the proliferation. Allergens also upregulated cytokines IL-1alpha, granulocyte-macrophage colony-stimulating factor, Gro-alpha and IL-12 in keratinocytes. Further, keratinocytes activated by allergens induced polarization of activated T lymphocytes to the Th1 phenotype.

Role of different valence states of chromium in the elicitation of allergic contact dermatitis

Chromium, a known contact sensitizer, is present at high levels in certain detergent bars (40-50 p.p.m.) sold in India. A concern was whether chromium present in such detergent bars could sensitize users or their use lead to the elicitation of allergic contact dermatitis. Chromium present in detergent bars was analyzed for its valence state. It was found to be trivalent [Cr (III)] and not hexavalent [Cr (VI)]. An elicitation test on normal volunteers, as well as on volunteers who were sensitive to chromium, was carried out to determine the elicitation potential of chromium (III) in the bars. Of the 48 volunteers who completed the study, 30 did not show any positive response to either potassium dichromate, the positive control, or the detergent bar containing chromium (III). 18 volunteers who were identified as chromium-sensitive showed a positive response to potassium dichromate but not to the detergent bar containing trivalent chromium. This study clearly showed that the detergent bar with 40-50 p.p.m. of trivalent chromium did not elicit any allergic contact dermatitis even in individuals known to be chromium-sensitive. Hexavalent chromium (potassium dichromate) did however, elicit allergic contact dermatitis in these subjects.

In vitro regeneration of roots of Phyla nodiflora and Leptadenia reticulata, and comparison of roots from cultured and natural plants for secondary metabolites

Adventitious roots, generated using leaf explants of P. nodiflora, and meristem explants of L. reticulata, were cultured on Murashige and Skoog (MS) medium supplemented with napthylacetic acid (2 microM) and indole butyric acid (3 microM) respectively. After 30 days, subculturing of roots in liquid MS medium with napthylacetic acid (1.5 microM) for P. nodiflora and indole butyric acid (3 microM) for L. reticulata afforded considerable increase in root mass. HPTLC profiles and microscopic examination of transverse sections of in vitro and naturally grown roots provided information on secondary metabolite accumulation vis-à-vis developmental stages of the root.

Alopecia universalis in a case of systemic lupus erythematosus

We report a case of systemic lupus erythematosus (SLE) who presented with alopecia universalis. MR, a 23 years female patient was admitted with alopecia universalis and other features of SLE like peripheral arthritis, fever, nephritis, butterfly rash over the malar regions, positive ANA and anti-ds DNA antibodies. There was a gap of four years between the onset of alopecia universalis and other clinical features of SLE. The alopecia was of non-scarry variety and responded to systemic and topical steroids.

Pesticide (acephate) removal by GAC: a case study

Pesticides are persistent pollutants which need utmost attention in agricultural pollution. They usually accumulate in the food chain, and hence are hazardous in nature. The present study reports the performance of granular activated carbon (GAC) in the removal of acephate contained in the effluent of a nearby pesticide manufacturing industry. In the batch study, the optimum dose of GAC was found to be 85 gm/litre for almost 100% removal of acephate from its initial concentration of 2.9 mg/litre which was found in the industrial effluent under treatment. The adsorption kinetics were represented closely by Langmuir isotherm. The equilibrium time was found as 80 minutes. The adsorptive capacity of GAC for acephate (pesticide) was of the order of 0.04614 mg/gm. A column system was devised and designed based on bed depth-service time (BDST) approach with the experimental value of 'a' and 'b' as 6.125 and 47.75 respectively.