Analysis of cutaneous adverse drug reactions in a tertiary care hospital in South Tamil Nadu

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently reported adverse drug reactions (10 to 30%) with overall incidence of 6.2/1000 cases in India and 8% of hospitalisation among Dermatology inpatients. The aim was to analyse the CADRs with reference to its prevalence, causative drugs, morphological patterns, polypharmacy and drug reaction severity by Hartwig’s severity assessment scale.Methods: This study was a retrospective study done in the Department of Dermatology, Venereology and Leprosy (DVL) over a period of 5 years (2015 to 2019) from CADR registers. Mean, standard deviation and chi square test were used for statistical analysis. P≤0.05 was considered as statistically significant.Results: A total of 134 cases of CADRs were encountered which comprised 0.2% (2/1000) of total OP census with equal gender ratio and involved most commonly the younger adults. The drug groups mainly responsible were anticonvulsants (24.7%) followed by non-steroidal anti-inflammatory drugs (NSAIDS) (22.5%), antibiotics (20.9%) followed by antiretrovirals (ART) and antituberculous drugs (ATT). The common morphological patterns were acute exanthem (32.2%), exfoliative dermatitis (14.9%) and toxic epidermal necrolysis (14.2%). Over the counter drugs accounted for 25.6% of cases. Around 38.1% were on polypharmacy. In this study, 15.7% had mild CADR, 53.7% had moderate and 30.6% had severe drug reactions with 2.2% mortality based on the Hartwig’s severity assessment scale. Commonest cause of severe CADRs was anticonvulsants and benign CADRs was NSAIDS.Conclusions: Proper history taking and documentation of data, recollection of sequence of events by the patient and drug re-challenge will help us in deciding the causative drug preventing further occurrence

Output Mode Switching for Parallel Five-bar Manipulators Using a Graph-based Path Planner

The configuration manifolds of parallel manipulators exhibit more nonlinearity than serial manipulators. Qualitatively, they can be seen to possess extra folds. By projecting such manifolds onto spaces of engineering relevance, such as an output workspace or an input actuator space, these folds cast edges that exhibit nonsmooth behavior. For example, inside the global workspace bounds of a five-bar linkage appear several local workspace bounds that only constrain certain output modes of the mechanism. The presence of such boundaries, which manifest in both input and output projections, serve as a source of confusion when these projections are studied exclusively instead of the configuration manifold itself. Particularly, the design of nonsymmetric parallel manipulators has been confounded by the presence of exotic projections in their input and output spaces. In this paper, we represent the configuration space with a radius graph, then weight each edge by solving an optimization problem using homotopy continuation to quantify transmission quality. We then employ a graph path planner to approximate geodesics between configuration points that avoid regions of low transmission quality. Our methodology automatically generates paths capable of transitioning between non-neighboring output modes, a motion which involves osculating multiple workspace boundaries (local, global, or both). We apply our technique to two nonsymmetric five-bar examples that demonstrate how transmission properties and other characteristics of the workspace can be selected by switching output modes.Comment: 7 pages, 6 figure

Micropropagation and conservation of selected endangered anticancer medicinal plants from the Western Ghats of India

Globally, cancer is a constant battle which severely affects the human population. The major limitations of the anticancer drugs are the deleterious side effects on the quality of life. Plants play a vital role in curing many diseases with minimal or no side effects. Phytocompounds derived from various medicinal plants serve as the best source of drugs to treat cancer. The global demand for phytomedicines is mostly reached by the medicinal herbs from the tropical nations of the world even though many plant species are threatened with extinction. India is one of the mega diverse countries of the world due to its ecological habitats, latitudinal variation, and diverse climatic range. Western Ghats of India is one of the most important depositories of endemic herbs. It is found along the stretch of south western part of India and constitutes rain forest with more than 4000 diverse medicinal plant species. In recent times, many of these therapeutically valued herbs have become endangered and are being included under the red-listed plant category in this region. Due to a sharp rise in the demand for plant-based products, this rich collection is diminishing at an alarming rate that eventually triggered dangerous to biodiversity. Thus, conservation of the endangered medicinal plants has become a matter of importance. The conservation by using only in situ approaches may not be sufficient enough to safeguard such a huge bio-resource of endangered medicinal plants. Hence, the use of biotechnological methods would be vital to complement the ex vitro protection programs and help to reestablish endangered plant species. In this backdrop, the key tools of biotechnology that could assist plant conservation were developed in terms of in vitro regeneration, seed banking, DNA storage, pollen storage, germplasm storage, gene bank (field gene banking), tissue bank, and cryopreservation. In this chapter, an attempt has been made to critically review major endangered medicinal plants that possess anticancer compounds and their conservation aspects by integrating various biotechnological tool

Clinical study of Profile of Adolescent Dermatoses and their Effect on Quality Of Life in Adolescents: Prospective Observational study in a Tertiary Care Hospital in South India

INTRODUCTION: The adolescent period is considered very critical, as many skin diseases which presented first during childhood begin to exert most damaging effects after the onset of puberty and many diseases manifest first during adolescent period. The diseases in adolescents may appear trivial but may have huge impact on quality of life and hence measuring quality of life in them is very important. AIMS & OBJECTIVES: 1. To study the patterns of skin diseases among adolescents visiting dermatology OPD and adolescent clinic in pediatric OPD. 2. To assess the effect of skin diseases on quality of life of adolescents in age group 16 – 19 years. 3. To study prevalence of steroid abuse in adolescents. METHODOLOGY: Our study was a prospective observational study in which we recruited 358 adolescents (10-19 years) who attended Dermatology OPD and Adolescent clinic in Paediatric OPD, TVMCH between January 2018 and December 2018. They were examined to identify the patterns of dermatoses, history of steroid abuse was enquired and Dermatology Life Quality Index (DLQI) questionnaire was given to them to assess the effect on quality of life. RESULTS: The prevalence of adolescent dermatoses in our hospital was 2.3%, most of the patients belonging to the late adolescent age group (56.4%) with male to female ratio of 1.3:1. Infections were the most common found in 39.1% of cases, followed by infestations (16.2%), appendageal disorders (13.1%), dermatitis (8.1%), papulosquamous disorders(3.9%), keratinisation disorders (3.9 %), urticaria (2.7%) and other miscellaneous diseases. Most of the patients (29.6%) took self-medication (over the counter) prior to presentation while 21.8% patients took native treatment and only 12.5% consulted Dermatologists. Around 13.6% of adolescents had history of inappropriate use of topical steroids with most common indication being dermatophytosis (61.2%) followed by skin lightening (16.3%). Quality of life was affected in 84.6% of adolescents with most of them (37.43%) having small effect of their diseases on quality of life. The most common domain affected was “symptoms and feelings” in 82.4% of patients. The diseases with the high mean DLQI scores were hyperhidrosis followed by dermatophytosis, scabies, pediculosis, pyoderma, acne, tuberous sclerosis, seborrheic dermatitis, psoriasis, ichthyosis, neurofibromatosis, urticaria, prurigo simplex, vitiligo, herpes simplex infections. CONCLUSION: Our study reported higher prevalence of infections which can be prevented by proper hygiene practices and sanitation. In spite of activities of IADVL’s taskforce against topical steroid abuse, still there is high prevalence of topical steroid abuse among adolescents and though government is keen on improving speciality services, many still use over the counter medications. We observed that though the skin diseases may appear trivial the magnitude caused by them is huge. Hence more studies on quality of life are needed in future

Clinicoetiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis spectrum and the correlation of SCORTEN with prognosis

Background: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse reactions of major concern because of its high mortality. The prognosis of SJS and TEN is widely assessed with SCORTEN (SCORe of TEN). Although, it is a largely useful scale, the predictive ability is still variable. Aims and Objectives: This study was conducted to assess the clinicoetiological profile and outcome of SJS and TEN and to evaluate the validity of SCORTEN in assessing the prognosis in South Indian population. Methods: This prospective observational study was conducted in the Department of Dermatology, Venereology and Leprosy in a Tertiary care hospital from January 2016 to June 2017. Detailed history, examination findings, treatment and SCORTEN scores were recorded. SCORTEN's accuracy in predicting the mortality was assessed on day 1, 3 and 5 of admission. Results: The incidence of SJS/TEN among other drug reactions was 29.5%. The most common age group affected was 30-49years (41.1%), with male preponderance (76.5%). The age range of patients was 6 and 67 years. TEN (64.7%) was the predominant spectrum followed by SJS and SJS-TEN overlap in 17.6% each. Anticonvulsants (47%) were the commonest causative drug, followed by analgesics (35%) and antibiotics (11%). The validity of SCORTEN was the same on days 1, 3, and 5. There was good agreement between the actual and predicted mortality on all three days. A mortality of 17.6% (3 cases) was recorded in this study. Three patients (17.6%) died in our study. All survivors had a score of 4 or less. The predicted mortalities were 0.417, 1.836, and 2.574 and the observed mortalities were 0, 2, and 1 in SJS, SJS-TEN overlap, and TEN respectively. Analysis of SCORTEN on a single day, either day 1, 3, or 5 was found to be as useful as the serial analysis. Conclusion: SCORTEN gave a significant estimation of mortality in SJS-TEN overlap patients, whereas it overestimated mortality in TEN patients. An increase in individual scores for the elevation of blood urea nitrogen (BUN) in existing SCORTEN and the inclusion of new parameters like raised liver enzymes, thrombocytopenia, and pulmonary infiltrates aided in proposing a modified SCORTEN for the South Indian population. Further studies on a larger scale, are needed to validate the modified SCORTEN proposed by us

Assessment of Planting Method and Deficit Irrigation Impacts on Physio-Morphology, Grain Yield and Water Use Efficiency of Maize (Zea mays L.) on Vertisols of Semi-Arid Tropics

Agriculture in a water-limited environment is critically important for today and for the future. This research evaluates the impact of deficit irrigation in different planting methods on the physio-morphological traits, grain yield and WUE of maize (Zea mays L.). The experiment was carried out in 2015 and 2016, consisting of three planting methods (i.e., BBF, SNF, and DWF) and four irrigation levels (i.e., I10D: irrigation once in ten days, I40: irrigation at 40% DASM, I50: irrigation at 50% DASM, and I60: irrigation at 60% DASM). The results reveal that varying degrees of water stress due to planting methods and irrigation levels greatly influenced the maize physio-morphological traits and yield attributes. The combined effect of DWF + I50 benefited the maize in terms of higher leaf area, RWC, SPAD values, CGR, and LAD, followed by the SNF method at 60 DAS. As a result, DWF + I50 and SNF + I50 had higher 100 grain weight (30.5 to 31.8 g), cob weight (181.4 to 189.6 g cob−1) and grain yield (35.3% to 36.4%) compared to other treatments. However, the reduction in the number of irrigations (24.0%) under SNF + I50 resulted in a 34% water saving. Thus, under a water-limited situation in semi-arid tropics, the practice of the SNF method + I50 could be an alternative way to explore the physio-morphological benefits in maize