COVID-19 Health Pandemic

The COVID-19 pandemic has caused numerous deaths, drained resources, halted trade, and shattered economies across the world. Humankind is faced with the challenge of survival, putting a halt on the growth dynamics. Lockdowns imposed by governments have flattened the curve of COVID-19 victims, but only to delay the spread of the deadly virus. Till the time a complete cure is discovered, people have managed to find ways to prevent the spread of the virus by developing new norms of day-to-day survival. The study aims to highlight the COVID-19 crisis and measures to maintain sustainability in the new normal. The methodology used is primarily based on published literature and data. Findings of the study indicate that there is absolute uncertainty on ‘What Next' and ‘How'. Hence, it is concluded that any resurgence attempt to equipoise this catastrophe is predicted to be prolonged and so its end results.

CLINICAL EVALUATION OF AGNIKUMARA RAS IN DUSHTA PRATISHYAYA

In Ayurveda, the disease sinusitis can be co-related with “Dushta Pratishyaya” which arises as a complication of the disease “Pratishyaya”. A detailed description of Pratishyaya has been mentioned in Sushruta Samhita (Su. Ut 24/4). While explaining the complication of Pratishyaya, Dushta Pratishyaya has been mentioned. The features of the disease Dushta Pratishyaya, in general, is similar to that of Chronic Sinusitis in modern science. In modern medicine, management of Sinusitis includes Antibiotics, analgesics, Nasal steroids, Nasal Irrigation, Surgery etc. Even then there is no complete cure for Chronic Sinusitis through modern management. Hence to find out a solution through Ayurveda, Agnikumara Ras has been selected for the present study. Agni kumara Ras has been selected from the text Basavarajeeyam. It consists of five ingredients- Shuddha Vatsanabha, Maricha, Kushta, Mustha and Vacha. Keywords: Dushta Pratishyaya, Agnikumara Ras, Clinical evaluation

Efficacy of Itraconazole vs Itraconazole Plus Isotretinoin in Treatment of Chronic Tinea

Background: About 20 to 25% of the global population is affected by the fungal skin infections. Different antifungal drugs used in traditional doses have developed widespread resistance, necessitating the development of an efficient antifungal treatment. Objective: To assess efficacy of itraconazole vs itraconazole plus isotretinoin in treatment of chronic tinea. Methodology: This was comparative study conducted at the Department of Dermatology Qazi Hussain Ahmad Complex Nowshera and alshifa clinic and skin aesthetic, Nowshera for duration of one year from November 2020 to November 2021. In both group A and B, 40 individuals were taken randomly. Treatment of group A patients was done with oral itraconazole and isotretinoin while patients of group B treatment was done with oral itraconazole alone. All patients were monitored for four weeks to assess their responsiveness to therapy and side effects. Results: Complete cure response was recorded in all the patients of group A, while in group B, complete cure response was recorded in 20 (50%) patients. A statistically significant treatment response was observed between both the groups (p<0.05). There were 22 (55%) individuals in group A and 7 (17.5%) patients in group B who had cheilitis and dryness of the lips as major adverse effects. Conclusion: Our study concludes that combination therapy with oral itraconazole and isotretinoin is efficient and safe for the treatment of chronic tinea. Our study recommends conducting study based on large sample size for better results.

COMPARATIVE EFFICACY AND SAFETY OF SYSTEMIC TERBINAFINE AND ITRACONAZOLE IN RECALCITRANT TINEA CRURIS

Background: The prevalence of recalcitrant tinea is increasing despite available treatment options. Itraconazole and terbinane are the most commonly prescribed agents for tinea. The relative efcacy of both the drugs is under focus and no standard guidelines exist for the recalcitrant tinea. Objective:To compare their relative efcacy and safety of itraconazole and terbinane in recalcitrant tinea cruris patients. Methods: A prospective, randomized, open label study recruited 100 recalcitrant tinea cruris patients of 18-65 years age at dermatology OPD at GNDH hospital, Amritsar, India after obtaining Institutional Ethics Committee approval. Patients who consented for study and follow up were included. Impaired hepatic/ renal function, secondary bacterial infections or deep mycoses patients were excluded. After randomization, group Acomprised of 50 patients who were put on capsule itraconazole 100 mg BD and group B of 50 patients on tablet terbinane 250 mg OD for eight weeks. The treatment response was assessed as Complete cure, Treatment failure based on clinical (PGAScore) and mycological (KOH Smear) prole. Results: Itraconazole resulted in complete cure in 28 patients whereas terbinane cured 14 patients completely (p <0.05). Treatment failure were observed as 1 and 8 (itraconazole and terbinane respectively, p < 0.05). Both drugs had comparable safety prole with no serious adverse effects. Limitations of the study were short duration, small sample size and non-blinding. Conclusion:Itraconazole seems relatively more efcacious than terbinane in the treatment recalcitrant tinea cruris cases

Assisting Difficult Liver Operations Using 3D Printed Models

Liver cancer is estimated to be the fifth most common in the world, while it is also considered the third leading cause of cancer death. In cases of primary liver cancer, surgery in combination with chemotherapy and radiotherapy can lead to a complete cure or significantly increase the patient’s life expectancy. Since the liver is an organ that performs several critical functions in the human body, the precise estimation of the disease (position and size of tumors and its vicinity to vessels) plays a vital role in a successful operation. In some cases, the removal of the tumor may be successful, but the percentage of the hepatic remnant may not be sufficient to sustain life. Therefore, accurate imaging of the tumor of the liver and proper planning of a difficult surgery to remove tumor(s) from a patient’s liver can be a lifesaver and lead to a complete cure of the disease. The aim of the present study is the initial accurate representation of the liver (parenchyma, tumors, vessels) as a digital three-dimensional (3D) model using advanced image processing and machine learning techniques and its 3D printing in 1:1 scale representing the full size of the liver with the tumor(s). A model of this type has been used at our University surgical department to plan complex hepatobiliary surgeries, provide more accurate information to the patients and their families, as well as improve the training of medical students and resident surgeons and fellows.

Identification of Therapeutic Targets for the Selective Killing of HBV-Positive Hepatocytes

The hepatitis B virus (HBV) infection is a major risk factor for cirrhosis and hepatocellular carcinoma. Most infected individuals become lifelong carriers of HBV as the drugs currently used to treat the patients can only control the disease, thereby achieving functional cure (loss of the hepatitis B surface antigen) but not complete cure (elimination of infected hepatocytes). Therefore, we aimed to identify the target genes for the selective killing of HBV-positive hepatocytes to develop a novel therapy for the treatment of HBV infection. Our strategy was to recognize the conditionally essential genes that are essential for the survival of HBV-positive hepatocytes, but non-essential for the HBV-negative hepatocytes. Using microarray gene expression data curated from the Gene Expression Omnibus database and the known essential genes from the Online GEne Essentiality database, we used two approaches, comprising the random walk with restart algorithm and the support vector machine approach, to determine the potential targets for the selective killing of HBV-positive hepatocytes. The final candidate genes list obtained using these two approaches consisted of 36 target genes, which may be conditionally essential for the cell survival of HBV-positive hepatocytes; however, this requires further experimental validation. Therefore, the genes identified in this study can be used as potential drug targets to develop novel therapeutic strategies for the treatment of HBV, and may ultimately help in achieving the elusive goal of a complete cure for hepatitis B.

Efficacy of lasers for the management of dermatophyte toenail onychomycosis

Background: Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by non-dermatophyte molds (NDMs) and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blinded, controlled trials (RCTs) for USA FDA approval. The primary efficacy measure is complete cure (complete mycological and clinical cure). The secondary measures are clinical cure (usually {less than or equal to}10 % involvement of target nail) and mycological cure (negative microscopy and culture). Some lasers are FDA-approved for the mild temporary increase in clear nail; however, some practitioners attempt to use lasers to treat and cure onychomycosis. Methods: A systematic review of the literature was performed in July 2020 to evaluate the efficacy rates demonstrated by RCTs of laser monotherapy for dermatophyte onychomycosis of the great toenail. Results: RCTs assessing the efficacy of laser monotherapy for dermatophyte toenail onychomycosis are limited. Many studies measured cure rates via nails instead of patients, and performed only microscopy or culture, not both. Only one included study reported mycological cure rate in patients as negative light microscopy and culture (0%). The combined clinical cure rates in short- and long-pulsed laser studies were (13.0-16.7% and 25.9%, respectively). There was no study that reported the complete cure rate, however, one did report treatment success (mycological cure (negative microscopy and culture) and {less than or equal to}10% clinical involvement) in nails as 16.7%. Conclusions: The effectiveness of lasers as a therapeutic intervention for dermatophyte toenail onychomycosis is limited based on complete, mycological, and clinical cure rates. However, it may be possible to use different treatment parameters or lasers with a different wavelength to increase the efficacy. Lasers could be a potential management option for older patients and onychomycosis patients with coexisting conditions such as diabetes, liver and/or kidney diseases for whom systemic antifungal agents are contraindicated or have failed.