Tattoo removal "the artistic state of the art." Tattoo on forehead, nose, and chin: Successful removal with modified R20 technique using low-fluence Q-switched Nd YAG laser: A case report

BACKGROUND

Tattooing is an ancient practice that has been performed all over the world which is used to beautify the skin and augment beauty. Regrettable tattoos are treated with Q switch lasers, in many sessions, and the effectiveness is doubtful.

OBJECTIVES

The aim of this paper is to demonstrate how a unique protocol of R20 Q switch Nd YAG laser, can be employed successfully in removing long standing facial tattoos, in skin type IV, in an effective disciplined timing and cost wise modalities. The adopted method was a-4 single passes, with 20 minutes gap respectively.

METHODS AND RESULTS

A lady received the conventional Q switch laser at one session, with no noticeable results. On the other session, she received the R20 method, and an immediate whitening reaction was observed. No adverse reactions were noted.

CONCLUSION

The R20 Q technique is very effective tool in a single treatment session than the conventional multiple laser sessions, in tattoo removal, and I would invite other dermatologists utilize it in their clinical setting. This method does not need any newer laser technology, clears the tattoo fast, and cuts down unnecessary treatment duration and cost.

Impulse oscillometry

Pulmonary function testing involves a battery of tests from the simple pulse oximetry to the cardiopulmonary exercise testing. Impulse oscillometry (IOS) is one of the newly described pulmonary function tests. It is based on the old principle of forced oscillatory technique modified and refined as per research and advances. It involves the use of sound waves during normal tidal breathing, which gives information on oscillatory pressure-flow relationships and eventually resistance and reactance. The resistance at 20 Hz (R20) represents the resistance of the large airways. The resistance at 5 Hz (R5) means the total airway resistance. (R5-R20) reflects resistance in the small airways. The reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways. Resonant frequency and area of reactance are also measured. IOS has major uses in diagnosis and control of asthma in children and the elderly, where spirometry is otherwise normal. IOS has been studied in other respiratory diseases like COPD, ILD and supraglottic stenosis.

Newer trends in laser tattoo removal

Q switched lasers are the current gold standard for laser tattoo removal. Though these systems are generally quite effective in clearing tattoos & have an established safety record, certain limitations exist while following the standard protocol. To overcome these limitation newer techniques such as multipass method, combination treatments with chemical agent and other laser have been introduced. These methods help in faster, less painful and complication free tattoo removal.

Visualized changes in respiratory resistance and reactance along a time axis in smokers: a cross-sectional study

BACKGROUND

Early detection of changes in respiratory function in smokers is important for the prevention of chronic obstructive pulmonary disease (COPD). The objective of this study was to investigate any changes in the respiratory impedance of smokers with normal FEV1/FVC.

METHODS

We assessed and compared the impedance components, respiratory resistance, and reactance in both the inspiratory and expiratory phases of nonsmokers, smokers, and COPD patients.

RESULTS

Approximately 60% of smokers showed elevated resistance and a negative shift in reactance, mainly in the expiratory phase, as observed in COPD patients. Smokers showed an increased gap between the maximum and minimum R5 and X5 values (R5sub, X5sub) in comparison with nonsmokers. Furthermore, R5-R20 was significantly higher in smokers than in nonsmokers. The expiratory-inspiratory gaps in resistance and reactance were also significantly higher in smokers than in nonsmokers. In smokers and COPD patients, the magnitude of expiratory X5 was more negative than that in nonsmokers. In smokers with V·50/V·25≥3, R5-R20 was significantly higher than those in smokers with V·50/V·25<3.

CONCLUSIONS

Approximately 60% of smokers were shown to exhibit apparent impedance changes despite having normal FEV1/FVC values. Smoking-induced early remodeling of the small airways may be responsible for the observed changes in airway function of smokers. Further studies are necessary to determine if the change in respiratory impedance observed in smokers is an early indicator of COPD.

Barriers to rural households' participation in low-skilled off-farm labor markets: theory and empirical results from northern Ethiopia

Promotion of low-skilled off-farm rural labor market participation can be an important strategy to improve livelihoods and food security of the poor in developing countries. This paper investigates rural farm households’ participation in low-skilled off-farm labor markets with disaggregate data from a survey of 400 households in Tigray, the northern highlands of Ethiopia. Adopting Heckman’s two stage approach, we examined households’ decisions to participate or not in markets by probit model in the first stage and level of participation by ordinary least squares procedures in the second stage. The results show that households’ decision to enter into a labor market significantly depends on the characteristics of the households such as sex, age of the household heads and labor endowments in the households. Similarly, the level of participation in labor markets measured by the amount of off-farm wage income depends on labor endowments in the households and the place where the households are located. Since cash constrained rural households do not find themselves advantageous to participate in off-farm labor markets, the reduction of cash constraint is the major policy implication of the paper. This holds true in general for all cash constrained rural households in developing countries. Similarly, the empirical results in the paper suggest removal of locational barriers to access labor markets. This helps them to earn off-farm income. It is necessary to eliminate (or at least reduce) obstacles for rural households to enter into a market of off-farm wage earning activities. This holds true in general for all rural households in developing countries. This paper is therefore expected to contribute to frame appropriate policy that promotes participation in low-skilled off-farm rural labor markets in developing countries where many rural households are not only poor but also low-skilled.