The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

I first read Davidson 30 years ago: at that time it was already in its 5th edition. A brief comparison shows that it then contained about 440,000 words in 1,100 pages: the current edition has compressed 625,000 words into 800 pages. I think I bought it as a student because it was cheap: but also because it seemed to be comprehensive and straightforward, and I have used it as a basis for my medical knowledge ever since. So I miss some of the old pictures of the acute skin rashes such as scarlet fever: in fact infectious disease has been transferred to the back and genetic factors take the first chapters. But careful linguistic comparison will still uncover the old phrases which some of us know by heart-there are minor changes such as 'alarming reactions to intravenous iron are uncommon, but have occasionally been noted', which becomes 'alarming systemic anaphyllactic reactions can occur'. Sir Stanley Davidson made 'no attempt to describe every rare disease or syndrome, but devoted most of the space available to those disorders most commonly encountered in practice'. I have grown up with successive editions, and have gradually come to appreciate the problems of the authors in the compression of knowledge. Having got to know many of them personally as real people rather than as names I can still recommend the book. It is the essential starting point for the study of internal medicine and for many doctors will remain their base reference work. The present editors have kept up-to-date and been prepared to prune the dead wood. There are many competitors in the market, and the publishers must take care with layout and illustration, although Davidson is still the best value for money. I will continue to recommend it to my clinical students: they will need to read it and know it to pass final MB. Postgraduates will need to remember the facts, but also to be able to place them in a broader perspective. The older consultant will still happily read it, and to get to know the authors themselves is really to complete your medical education. Dr John Macleod and his team have successfully kept alive the primary objective 'to provide a rational and easily comprehensible basis for the practice of medicine'. The book is economical in price and compact in size, but still contains the essential truths for the practice of good medicine.

Davidson's Principles and Practice of Medicine

Fitzpatrickʼs Dermatology in General Medicine

I. Leonard Bernstein, MD; James T. Li, MD, PhD; David I. Bernstein, MD; Robert Hamilton, PhD, DABMLI; Sheldon L. Spector, MD; Ricardo Tan, MD; Scott Sicherer, MD; David B. K. Golden, MD; David A. Khan, MD; Richard A. Nicklas, MD; Jay M. Portnoy, MD; Joann Blessing-Moore, MD; Linda Cox, MD; David M. Lang, MD; John Oppenheimer, MD; Christopher C. Randolph, MD; Diane E. Schuller, MD; Stephen A. Tilles, MD; Dana V. Wallace, MD; Estelle Levetin, PhD; and Richard Weber, MD

/pdf/allergy-diagnostic-testing-an-updated-practice-parameter-21api4satq.pdf

Allergy diagnostic testing: An updated practice parameter

History of tuberculosis

Background Shoe dermatitis is a form of contact dermatitis resulting from exposure to shoes Different chemicals, in conjunction with a hot and humid environment within the shoe, give rise to allergic or irritant dermatitis Allergic shoe dermatitis is commonly caused by constituents of rubber, leather, adhesives, and rarely by linings and dyes



Aim To determine the frequency of various allergens in shoe dermatitis in our patients



Methods One hundred and nine patients suspected of having contact dermatitis due to shoe allergens were included All patients were patch tested with the Shoe series and European Standard series Patches were applied on the upper back and removed after 48 h Results were read at 48, 72, and 120 h and interpreted according to International Contact Dermatitis Research Group (ICDRG) criteria



Results Of the 119 patients, 87 (73%) reacted positively to various allergens, 48% of whom showed polysensitivity Glues (336%), particularly para-tert-butylphenol formaldehyde resin (PTBP-FR) (269%), were the leading cause of shoe dermatitis Other allergens were leather chemicals (264%), potassium dichromate (1618%), rubber allergens (76%), and dyes (76%) Shoe scrapings tested positive in 263% of patients Other common allergens were nickel sulfate (227%), neomycin sulfate (101%), and cobalt chloride (84%)



Conclusions Considering the diversity of allergens, all patients presenting with shoe dermatitis should be patch tested with the Shoe series and a standard series to determine the etiologic allergens

Common allergens in shoe dermatitis: our experience in Lahore, Pakistan.

Results Of 350 patients, 215 (61%) were positive on patch testing. Positivity to 1 allergen was seen in 35%, and to 2 more allergens in 26% of patients. Results were considered relevant in 47% of patients. Table 1 enlists the top 11 allergens, positive in more than 2% of patients. Other positive allergens, with a frequency of less than 2%, were epoxy resin, lanolin alcohol, parabens, N-isopropyl-N-phenyl-4-phenylenediamine, quaternium-15, quinolone mix, Myroxylon Pereirae resin, mercapto mix,

Suitability of the European standard series of patch test allergens in Pakistani patients.

Background Treatment of vitiligo still remains a challenge. New modalities are added every now and then for non-responding patches. Needling is relatively recent addition. Objectives To assess the usefulness of needling as an adjunct to narrowband ultraviolet B therapy in non-responding, localized fixed vitiligo Patients and methods 23 adult cases (16 female and 7 male) having 84 localized vitiligo patches, who did not respond to medical measures either alone or in combination with ultraviolet exposures were available for evaluation at the end of study. After preliminary investigations, patients were subjected to needling of the involved sites. Many of them were trained to perform needling themselves. Patients were then treated with thrice weekly narrowband ultraviolet B (NBUVB) therapy. Results Almost 90 % patches showed good to excellent response after six months of needling with NBUVB exposures without much of side effects. Conclusion Needling is a safe, effective and promising adjunct treatment to NBUVB for repigmentation of non-responding localized vitiligo.

https://www.jpad.com.pk/index.php/jpad/article/download/585/558

Needling: an adjunct to narrowband ultraviolet B therapy in localized fixed vitiligo

Background Parthenium hysterophorus is a waste land weed which is hazardous to plants and human beings. Objectives To find out the magnitude of parthenium spread and the adverse effects on agriculture and human beings. Patients and methods This multiphase study was designed in collaboration with the Department of Mycology and Plant Pathology (MAPP), Punjab University, Lahore. In phase I, the plant itself was studied. In phase II, its effects on other plants were recorded. In phase III, patch test was performed in patients with allergic contact dermatitis visiting the medical camps at Jallo Park, and Johar town, Lahore and Changa Manga forest. Patch test was done using the leaf and flower of prthenium, as is, and 1% parthenin in petrolatum base. International Contact Dermatitis Research Group (ICDRG) guidelines and criteria were used for patch testing and interpreting the results at 48, 72 and 120 hours. Results In the first phase of the study, the weed was found growing unchecked in the above mentioned areas. In the second phase, it was found to invade crops like rice and maize. In the third phase of the study, 511 patients suspected of allergic contact dermatitis were enrolled along with 100 controls. Out of 511, 391 reacted positively. Only 5 from the control group were positive to parthenium. Conclusion Parthenium hysterophorus has replaced the main native flora in many parts of Pakistan including the big cities like Rawalpindi-Islamabad and Lahore. It has caused a major outbreak of airborne contact dermatitis. The rapid spread is probably due to its use in bouquets.

https://www.jpad.com.pk/index.php/jpad/article/download/609/582

Parthenium weed: a growing concern in Pakistan

Immunofluorescence has become an essential component of today’s dermatological laboratory. During the last four decades, innovations in this field have revolutionized the concepts about the pathogenesis, diagnosis and differential diagnosis of autoimmune bullous diseases, hereditary bullous diseases, collagen-vascular diseases, many inflammatory dermatoses and cutaneous tumours. However, the facility is not widely available in Pakistan, and the physicians’ knowledge about this diagnostic tool is mostly theoretical. This review envisages the basics of immunofluorescence technique, the interpretation of the results and the newer advancements in the field which a physician is expected to know.

http://www.jpad.com.pk/index.php/jpad/article/download/736/701

Zahida Rani

Papers

Common allergens in shoe dermatitis: our experience in Lahore, Pakistan.

Suitability of the European standard series of patch test allergens in Pakistani patients.

Needling: an adjunct to narrowband ultraviolet B therapy in localized fixed vitiligo

Parthenium weed: a growing concern in Pakistan

Immunofluorescence in immunobullous diseases