Fitzpatrickʼs Dermatology in General Medicine

Multiple sclerosis (MS) is a chronic inflammatory demyelinating central nervous system disease that typically strikes young adults, especially women. The pathobiology of MS includes inflammatory and neurodegenerative mechanisms that affect both white and gray matter. These mechanisms underlie the relapsing, and often eventually progressive, course of MS, which is heterogeneous; confident prediction of long-term individual prognosis is not yet possible. However, because revised MS diagnostic criteria that incorporate neuroimaging data facilitate early diagnosis, most patients are faced with making important long-term treatment decisions, most notably the use and selection of disease-modifying therapy (DMT). Currently, there are 10 approved MS DMTs with varying degrees of efficacy for reducing relapse risk and preserving neurological function, but their long-term benefits remain unclear. Moreover, available DMTs differ with respect to the route and frequency of administration, tolerability and likelihood of treatment adherence, common adverse effects, risk of major toxicity, and pregnancy-related risks. Thorough understanding of the benefit-risk profiles of these therapies is necessary to establish logical and safe treatment plans for individuals with MS. We review the available evidence supporting risk-benefit profiles for available and emerging DMTs. We also assess the place of individual DMTs within the context of several different MS management strategies, including those currently in use (sequential monotherapy, escalation therapy, and induction and maintenance therapy) and others that may soon become feasible (combination approaches and "personalized medicine"). We conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from January 1, 1990, to August 31, 2013. The following search terms were used: multiple sclerosis, randomized controlled trials, interferon-beta, glatiramer acetate, mitoxantrone, natalizumab, fingolimod, teriflunomide, dimethyl fumarate, BG-12, alemtuzumab, rituximab, ocrelizumab, daclizumab, neutralizing antibodies, progressive multifocal leukoencephalopathy.

Multiple Sclerosis: Current and Emerging Disease-Modifying Therapies and Treatment Strategies

The present study reports biologically oriented process for green synthesis of CuO nanoparticles by using eco-friendly and non-toxic Aloe vera leaf extract. Powder X-ray diffraction and transmission electron microscope analysis revealed that synthesized CuO nanoparticles are in monoclinic phase with average particle size of 20 nm. The antibacterial activity of green synthesized CuO nanoparticles was tested against three bacterial fish pathogens “viz:” Aeromonas hydrophila, Pseudomonas fluorescens and Flavobacterium branchiophilum, which are responsible for causing severe infectious diseases in fishes. CuO NPs exhibits enhanced antibacterial activity against all the fish pathogens even at lower concentrations, i.e. above 20 μg/mL.

Green Synthesis of Copper Oxide Nanoparticles Using Aloe vera Leaf Extract and Its Antibacterial Activity Against Fish Bacterial Pathogens

Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter

This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine

https://journals.sagepub.com/doi/pdf/10.1258/jrsm.2010.100104

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

Aloe vera is a natural product that is now a day frequently used in the field of cosmetology. Though there are various indications for its use, controlled trials are needed to determine its real efficacy. The aloe vera plant, its properties, mechanism of action and clinical uses are briefly reviewed in this article.

Aloe vera: a short review

Background: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species, and resistance to treatment are the characteristics of onychomycosis in HIV. Aim: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically. Methods: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e., 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study. Results: Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus, and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp., Scytalidium hyalinum, Penicillium spp., and Gymnoascus dankaliensis on 1 each. Conclusions: Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

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A clinical and mycological study of onychomycosis in HIV infection.

India has approximately 5.2 million persons infected with HIV. Although antiretroviral therapy (ART) is being widely introduced in public clinics, many HIV-infected persons still seek care via the private sector. A cross-sectional survey was conducted in 2004 at six public and private sites to characterize the knowledge, attitudes, and practices (KAP) of ART among patients with HIV receiving care in India. Of 1667 persons surveyed, 609 (36%) had heard of ART and 19% of these persons reported that ART could cure HIV. Twenty-four percent reported that they were currently taking ART, with 18% of these patients not actually on ART according to their provider. Major barriers to taking ART were cost (33%), lack of knowledge of ART (41%), and deferral by physician (30%). More than half of all public and private patients had not heard of CD4 (57%) or viral load testing (80%), and even fewer had received these tests (32% and 11%, respectively). Private clinic attendees were almost 4 times more likely to be on ART ...

Knowledge, attitudes, and practices of antiretroviral therapy among HIV-infected adults attending private and public clinics in India.

INTRODUCTION of case reports nd case-series dealing with IRIS and the name IRD was given for the phenomenon Antiretroviral therapy (ART) strengthens the immune prior to 2000. Joseph A. De Simone and colleagues system and restores protective pathogen-specific from Thomas Jefferson University in Philadelphia were immune responses. This results in decreased incidence one of the first groups who attempted to define of opportunistic infections (OI), decrease in the viral immune reconstitution syndrome in 2000. load and increase in the CD4 counts. With restoration found that many HIV-positive people developed a of immunity, the body begins to fight aggressively spectrum of illnesses once they responded to HAART against coexisting infection thereby causing atypical They developed conditions such as Mycobacterium manifestations of opportunistic infections, which may avium complex (MAC) infection and cryptococcal cause severe inflammation in tissue. The constellation meningitis, at a time when their immune function of clinical symptoms, signs or investigational was actually improving. Initially it was considered to parameters resulting from such inflammatory response be a Jarisch-Herxheimer or lepra-like reaction. Later has been variously called immune reconstitution it was found to be due to the restoration of immunity inflammatory syndrome (IRIS) or immune restoration thereby eliciting hypersensitivity reaction to an disease (IRD) or immune rebound illness. existing microbe or antigen in the body. De Simone and his colleagues named this relatively uncommon IRIS is defined as occurrence or worsening of clinical phenomenon as immune reconstitution syndrome. and/or laboratory parameters despite a favorable They

Immune reconstitution inflammatory syndrome.

Adherence to antiretroviral therapy (ART) is critical in maintaining viral suppression and minimizing resistance in HIV-infected patients. We compared physician estimates of their patients...

/pdf/physician-estimate-of-antiretroviral-adherence-in-india-poor-2tsvt5exhb.pdf

D G Saple

Papers

Aloe vera: a short review

A clinical and mycological study of onychomycosis in HIV infection.

Knowledge, attitudes, and practices of antiretroviral therapy among HIV-infected adults attending private and public clinics in India.

Immune reconstitution inflammatory syndrome.

Physician estimate of antiretroviral adherence in India: poor correlation with patient self-report and viral load.