Tretinoin Peels versus Glycolic Acid Peels in the Treatment of Melasma in Dark-Skinned Patients

BACKGROUND: Chemical peels have become a popular method for treating melasma. Although daily topical 0.05 and 0.1% tretinoin have been used for melasma, the therapy takes at least 4 to 6 months to produce clinically significant lightening. In a recent trial, 1% tretinoin peel has shown good clinical and histologic results after biweekly applications in 2.5 weeks only in the treatment of melasma. OBJECTIVE: Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent versus a standard peeling agent, 70% glycolic acid, in the treatment of melasma in Indian women. METHODS: Ten female patients of melasma, after written consent, were taken up for an open left-right comparison pilot study of 12 weeks. One percent tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other at weekly intervals. The results were evaluated by a clinical investigator by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks. RESULTS: A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed on both facial sides (p<0.001). Nevertheless, there was no statistically significant difference between the right and the left sides. Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients. CONCLUSIONS: It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel, 70% glycolic acid, although larger trials over longer periods may be necessary to substantiate such findings.     

TISSUE GRAFTS IN VITILIGO SURGERY �C PAST, PRESENT, AND FUTURE

Vitiligo, characterized by depigmented macules is a common disorder with a high psychosocial impact, particularly in darker skins. Surgical methods become important in cases where medical therapy fails to cause repigmentation or in cases of segmental vitiligo where the response to surgery is excellent. The basic principle of surgical treatment is autologous grafting of viable melanocytes from pigmented donor skin to recipient vitiliginous areas. Various grafting methods have been described including tissue grafts and cellular grafts. Stability of the disease is the most important criterion to obtain a successful outcome. Counseling of the patient regarding the outcome is vital before surgery. The technique and followup management of the tissue grafts has been described in detail in this review.     

A Pharmacovigilance Study of Adverse Drug Reactions Reported for Cardiovascular Disease Medications Approved Between 2012 and 2017 in the United States Food and Drug Administration Adverse Event Reporting System (FAERS) Database

Cardiovascular Drugs and Therapy - Between 2012 and 2017, the FDA approved 29 therapies for a cardiovascular disease (CVD) indication. Due to the limited literature on patient safety outcomes for...     

Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients

The present study was conducted in Indian rheumatoid arthritis (RA) patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) to determine the incidence and type of adverse drug reactions (ADRs) leading to their withdrawal in the initial 6 months of therapy. This was considered important as pharmacogenetic variations in the pattern of RA in different populations and genetic differences in efficacy and safety to drugs demand separate studies to be conducted in different populations. Hospital records were used to identify 1,000 consecutive patients with RA fulfilling the American College of Rheumatology criteria and having at least 6-month follow-up. Age, gender, duration of arthritis, drug usage and ADR-related drug withdrawal were recorded from the charts. Most of the patients were put on single DMARD. Combined use of DMARD was less frequent and non-use of DMARD was common; however, disease control was good. The commonest DMARD used in our hospital was hydroxychloroquine 444 (44%) and the commonest combination used was methotrexate with hydroxychloroquine by 55 (6%). Sulphasalazine use showed preference to young and males. Supportive drugs used were NSAIDs by 883 (88%), corticosteroids by 646 (65%), paracetamol by 594 (59%) and amitriptyline by 88 (9%). Incidence of ADR-related DMARD withdrawal was maximum with leflunomide 2/15 (13.33%) followed by methotrexate 9/116 (7.76%), sulphasalazine 6/185 (3.24%), chloroquine 3/131 (2.29%) and hydroxychloroquine 8/444 (1.8%). Severity and symptomatology of disease, genetic pattern of patients, financial status, previous experience of the clinicians and patients, availability of drugs, patient expectations and compliance were the main factors that lead to a difference in pattern of therapy in our patients compared to other population.     

The utility of vapor fixation for cell block preparation in fine needle aspiration of malignant lesions of lymph nodes

Cell blocks overcome certain limitations of fine needle aspiration cytology (FNAC), such as study of tissue architecture and application of immunohistochemistry (IHC). The main disadvantage of cell block by conventional method is cell loss. This study compares formaldehyde vapor-fixed cell blocks with conventional formalin-fixed blocks obtained from aspirates of malignant lesions of lymph nodes. Seventy-nine patients with suspected primary or metastatic malignancy in lymph nodes were studied. Cytologic smears were prepared in all the cases. Conventional formalin-fixed cell blocks were made in 34 cases, vapor-fixed cell blocks in 34 cases, and in the remaining 11 cases, both methods were employed. Cell block sections were compared for cellularity, fixation artifacts, morphologic details, and crispness of immunohistochemical staining using defined subjective criteria. Cellular yield was slightly less with vapor-fixed cell blocks in comparison with conventional formalin-fixed cell blocks. Staining artifacts were more frequent with vapor fixation (33.3%) as compared to conventional formalin fixation (20%). Also, vapor fixation required more time (6 h) as compared to conventional formalin fixation (1 h). There was no difference in the two techniques with respect to immunohistochemical staining. Cell blocks prepared by vapor fixation are comparable to conventional formalin-fixed cell blocks.     

Tricuspid regurgitation velocity and other biomarkers of mortality in children,adolescents and young adults with sickle cell disease in the United States: The PUSH study

In the US, mortality in sickle cell disease (SCD) increases after age 18-20 years. Biomarkers of mortality risk can identify patients who need intensive follow-up and early or novel interventions. We prospectively enrolled 510 SCD patients aged 3-20 years into an observational study in 2006-2010 and followed 497 patients for a median of 88 months (range 1-105). We hypothesized that elevated pulmonary artery systolic pressure as reflected in tricuspid regurgitation velocity (TRV) would be associated with mortality. Estimated survival to 18 years was 99% and to 25 years, 94%. Causes of death were known in seven of 10 patients: stroke in four (hemorrhagic two, infarctive one, unspecified one), multiorgan failure one, parvovirus B19 infection one, sudden death one. Baseline TRV ≥2.7 m/second (>2 SD above the mean in age-matched and gender-matched non-SCD controls) was observed in 20.0% of patients who died vs 4.6% of those who survived (P = .012 by the log rank test for equality of survival). The baseline variable most strongly associated with an elevated TRV was a high hemolytic rate. Additional biomarkers associated with mortality were ferritin ≥2000 μg/L (observed in 60% of patients who died vs 7.8% of survivors, P < .001), forced expiratory volume in 1 minute to forced vital capacity ratio (FEV1/FVC) <0.80 (71.4% of patients who died vs 18.8% of survivors, P < .001), and neutrophil count ≥10x10⁹/L (30.0% of patients who died vs 7.9% of survivors, P = .018). In SCD children, adolescents and young adults, steady-state elevations of TRV, ferritin and neutrophils and a low FEV1/FVC ratio may be biomarkers associated with increased risk of death.