Summary Background Previous systematic reviews have identified a high prevalence of HIV infection in transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in transgender women worldwide. We aimed to better assess the relative HIV burden in all transgender women worldwide. Methods We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in transgender women with that in adults in the countries for which data were available. Findings Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19·1% (95% CI 17·4–20·7) in 11 066 transgender women worldwide. In 7197 transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17·7% (95% CI 15·6–19·8). In 3869 transgender women sampled in five high-income countries, HIV prevalence was 21·6% (95% CI 18·8–24·3). The odds ratio for being infected with HIV in transgender women compared with all adults of reproductive age across the 15 countries was 48·8 (95% CI 21·2–76·3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries. Interpretation Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among transgender women. Funding Center for AIDS Research at Johns Hopkins and the Center for Public Health and Human Rights at the JHU Bloomberg School of Public Health.

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Worldwide burden of HIV in transgender women: a systematic review and meta-analysis

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed.

http://blackbook.com.br/wp-content/uploads/2014/02/OK-aad-2012-atopic-dermatitis-guideline-part-1-article-in-press.pdf

Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.

In patients with HIV-1 infection who are starting combination antiretroviral therapy (ART), the incidence of immune reconstitution inflammatory syndrome (IRIS) is not well defined. We did a meta-analysis to establish the incidence and lethality of the syndrome in patients with a range of previously diagnosed opportunistic infections, and examined the relation between occurrence and the degree of immunodeficiency. Systematic review identified 54 cohort studies of 13 103 patients starting ART, of whom 1699 developed IRIS. We calculated pooled cumulative incidences with 95% credibility intervals (CrI) by Bayesian methods and did a random-effects metaregression to analyse the relation between CD4 cell count and incidence of IRIS. In patients with previously diagnosed AIDS-defining illnesses, IRIS developed in 37.7% (95% CrI 26.6-49.4) of those with cytomegalovirus retinitis, 19.5% (6.7-44.8) of those with cryptococcal meningitis, 15.7% (9.7-24.5) of those with tuberculosis, 16.7% (2.3-50.7) of those with progressive multifocal leukoencephalopathy, and 6.4% (1.2-24.7) of those with Kaposi's sarcoma, and 12.2% (6.8-19.6) of those with herpes zoster. 16.1% (11.1-22.9) of unselected patients starting ART developed any type of IRIS. 4.5% (2.1-8.6) of patients with any type of IRIS died, 3.2% (0.7-9.2) of those with tuberculosis-associated IRIS died, and 20.8% (5.0-52.7) of those with cryptococcal meningitis died. Metaregression analyses showed that the risk of IRIS is associated with CD4 cell count at the start of ART, with a high risk in patients with fewer than 50 cells per microL. Occurrence of IRIS might therefore be reduced by initiation of ART before immunodeficiency becomes advanced.

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Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis.

Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor-alfa inhibitors have given clinicians more options against this difficult disease.

https://www.jaad.org/article/S0190-9622(09)00036-X/pdf

Hidradenitis suppurativa: A comprehensive review

Vitiligo is an acquired pigmentary disorder of unknown etiology that is clinically characterized by the development of white macules related to the selective loss of melanocytes. The prevalence of the disease is around 1% in the United States and in Europe, but ranges from less than 0.1% to greater than 8% worldwide. A recorded predominance of women may reflect their greater willingness to express concern about cosmetically relevant issues. Half of all patients develop the disease before 20 years of age. Onset at an advanced age occurs but is unusual, and should raise concerns about associated diseases, such as thyroid dysfunction, rheumatoid arthritis, diabetes mellitus, and alopecia areata. Generalized vitiligo is the most common clinical presentation and often involves the face and acral regions. The course of the disease is unpredictable and the response to treatment varies. Depigmentation may be the source of severe psychological distress, diminished quality of life, and increased risk of psychiatric morbidity. Part I of this two-part series describes the clinical presentation, histopathologic findings, and various hypotheses for the pathogenesis of vitiligo based on past and current research.

https://www.jaad.org/article/S0190-9622(11)00039-9/pdf

Vitiligo: A comprehensive overview: Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up

Indian J Dermatol Venereol Leprol

Throughout the world, bombs are one of the major weapons of violence, and a bomb blast can result in a complex, multidimensional injury pattern. It may induce physical injuries through the well-documented primary, secondary, tertiary and quaternary mechanisms of blast. These effects need special medical attention and timely execution of management strategies. Although the patterns of acute injuries after a blast are well documented in the literature, the delayed cutaneous effect seems to have gone unreported. We report a case of post-traumatic cataract formation and multiple itchy eruptions clinically resembling prurigo nodularis (PN), developing in a young girl after a bomb-blast injury. A 14-year-old girl presented with a gradually developing, extremely itchy skin eruption on her arms and face after being injured in a bombing incident 4 months previously. According to the patient, she had sustained multiple, tiny burn injuries immediately after the blast, which gradually healed within a couple of weeks. Almost simultaneously, the points of injury became pruritic, and about a month later, raised lesions had developed. The lesions were restricted precisely to the sites of original blast injury. In addition, the girl had loss of vision in her right eye. There were no other symptoms and no history of any other previous skin disease. On physical examination multiple, slightly erythematous, firm, nontender papules and nodules, 2–6 mm in size, were found, distributed mainly over the flexor aspect of the left forearm (Fig. 1a), face (Fig. 1b) and upper chest. A few scattered lesions were also visible on the right forearm. Other areas of the skin were healthy. There was no abnormality of the mucosae, hair or nails. Ophthalmological examination revealed right-sided post-traumatic cataract with irregular pupil. Laboratory investigations and psychological assessment of the patient were unremarkable. Routine laboratory tests including human immunodeficiency virus (HIV) serology tests were normal. Patch testing using the standard Indian battery of allergens was negative. Radiological imaging of the affected areas did not reveal any foreign bodies. (a)

Prurigo nodularis-like skin eruptions after bomb-blast injury.

“COVID arm:” Delayed local hypersensitivity reaction to ChAdOx1 nCoV-19 coronavirus vaccine

Carbon monoxide (CO) is a colorless, odorless gas produced as a by-product of the complete combustion of hydrocarbons. CO binds rapidly to Haemoglobin (Hb), leading to the formation of carboxyhemoglobin (COHb), so the oxygen-carrying capacity of the blood will be decreased and causing tissue hypoxia. We present the case of accidental carbon monoxide poisoning in a family where four members were reported dead and three unconscious in the morning after sleeping in a room with burning briquettes. Carbon monoxide poisoning can be fatal. Public awareness about such poisoning is essential for prevention.

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Mass Carbon Monoxide Poisoning in a Family: A Case Report from Nepalgunj

Background: Organophosphorus (OP) compounds are anti acetylcholinesterase, used abundantly as pesticides and often misused as poisoning agents. Irreversible inhibition of cholinesterase enzymes is attributed to the serious clinical outcomes in these patients. This study aims to identify the relationship between the serum cholinesterase (SChE) activity and outcome.
Material and Methods: A descriptive cross-sectional study conducted in the Department of Internal Medicine of Bir Hospital, Kathmandu from July 2019 to December 2019. 50 patients of OP poisoning were studied. Laboratory investigations including SChE activity were performed and their management and their outcomes were recorded and analyzed by using statistical package for social sciences (SPSS) version 20.
Results: Poisoning was more predominant in young adults of the age group of 15 to 35(68%) years. Most common compound used for poisoning was chlorpyriphos 50% + cypermethrin 5% followed by dichlorvos 85% and cypermethrin. Among 50 cases 48 cases were discharged after successful management while 2 cases expired. No significant relation between initial serum level of acetylcholinesterase and outcome was observed in this study with p- value >0.05. Significant relation between initial serum acetylcholinesterase level, duration of hospital stay, atropinization dose and hospital arrival time from ingestion of poison was found with p- value of <0.05.
Conclusion: There was a significant correlation between SCH levels and total atropinization dose, duration of hospital stay and hospital arrival time. However no significant correlation was found for the clinical outcome and need of mechanical ventilator.

Key words: organophosphorous poisoning, serum acetylcholinesterase, cholinesterase.

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R. K. Mandal

Papers

Indian J Dermatol Venereol Leprol

Prurigo nodularis-like skin eruptions after bomb-blast injury.

“COVID arm:” Delayed local hypersensitivity reaction to ChAdOx1 nCoV-19 coronavirus vaccine

Mass Carbon Monoxide Poisoning in a Family: A Case Report from Nepalgunj

Prognostic Value of Serum Cholinesterase in Acute Organophosphate Poisoning