Replacement and Immunomodulatory Activities of 20% Subcutaneous Immunoglobulin Treatment: A Single-Center Retrospective Study in Autoimmune Myositis and CVID Patients

BackgroundImmunoglobulin (Ig) replacement therapy represents a life-saving treatment in primary antibody deficiencies. The introduction of subcutaneous Ig (SCIg) administration brings a major improvement in quality of life for patients, compared to the traditional intravenous administration. In recent years, an additional role has been proposed for Ig therapy for various inflammatory and immune-mediated diseases. Consequently, the use of SCIg has expanded from immunodeficiencies to immune-mediated diseases, such as polymyositis (PM) and dermatomyositis (DM). Given the rarity of these conditions, it is still difficult to evaluate the real impact of SCIg treatment on PM and DM, and additional data are constantly required on this topic, particularly for long-term treatments in real-life settings.AimThis study aimed to increase the knowledge about the anti-inflammatory and immunomodulatory effects of SCIg treatment for myositis. To this aim, a long-term evaluation of the effectiveness of 20% human SCIg treatment (20% SCIg, Hizentra®, CSL Behring) was carried out in patients with PM/DM in care at our Center. In addition, an evaluation of the 20% SCIg therapy in CVID patients was provided. This analysis, beside adding knowledge about the use of SCIg therapy in this real-life setting, was intended as a term of comparison, regarding the safety profile.ResultsResults support the beneficial effect and tolerability of long-term 20% SCIg therapy in PM/DM patients, reporting a significant improvement in creatine kinase levels, muscle strength, skin conditions, dysphagia, disease activity (MITAX score) and disability (HAQ-DI score). None of the patients reported systemic reactions. The duration of the reported local reactions was a few hours in 80% of the patients, and all resolved spontaneously. CVID patients reported an improvement in all the considered effectiveness parameters at the end of 20% SCIg therapy. The frequency of the adverse events reported by PM/DM patients was not different from what reported in CVID patients, where the use of SCIg therapy is more consolidatedConclusionsThis study suggests that 20% SCIg treatment represents a viable and safe treatment for PM/DM patients and a valid therapeutic alternative to IVIg, with important advantages for patients’ quality of life.

Conservation Of Symphytum Officinale L. At Cmprh Garden, Emerald

Symphytum L. commonly called as comfrey, belongs to the family Boraginaceae. The genus of Symphytum L. have a great medicinal value and used to treat a wide variety of ailments viz., bronchial problems, sprains, broken bones, arthritis, acne and skin conditions whereas pharmacological effects of comfrey extracts are endorsed to several chemical compounds. In view of above point, the present study of Survey, Collection and Documentation of Symphytum species, were carried out in different places of India. The rhizomes of Symphytum species were collected from Mynala village of Nilgiris, subsequent survey were carried out to IIIM Chatha Research Farm Jammu Tawi during 2017-2018 and it was grown at CMPRH garden, Emerald to confirm the identification of plants species. This specimen was collected and preserved herbarium at CMPRH garden Emerald for future reference. Among plants parts roots and leaves are mostly used for homeopathic system of medicine and this species were maintained and reproduces subsequent year by seed and root fragments. Root cuttings are the least expensive method of propagation. In addition to that Performance of Symphytum officinale at Nilgiris conditions were observed and the results revealed that Symphytum officinale L. is an erect, perennial herb with thick root stock. Leaves oblong-lanceolate and flowers are blue in colour. The data on length of root ranged from 10-20 cm with black to brown colour. Similarly, the length of lower, middle and upper cauline leaves ranged from 32.3-37.2 cm, 25.2-27.8cm, 10.4- 13.2cm, respectively Whereas the width of the lower, middle, upper leaves ranged 12.5-17.4 cm , 7.6- 10.2cm , 3.4-4.1cm, respectively. Further, the studies on Symphytum officnale regarding root yield, dry matter ratio of leaves and roots as well as physiochemical properties other chemical compounds present and uses in homoeopathic system of the medicine under the Nilgiris condition are need to be studied elaborately in future.

Pharmaceutical nanotechnology: from the bench to the market

Background Nanotechnology is considered a new and rapidly emerging area in the pharmaceutical and medicinal field. Nanoparticles, as drug delivery systems, impart several advantages concerning improved efficacy as well as reduced adverse drug reactions. Main body Different types of nanosystems have been fabricated including carbon nanotubes, paramagnetic nanoparticles, dendrimers, nanoemulsions, etc. Physicochemical properties of the starting materials and the selected method of preparation play a significant aspect in determining the shape and characteristics of the developed nanoparticles. Dispersion of preformed polymers, coacervation, polymerization, nano-spray drying and supercritical fluid technology are among the most extensively used techniques for the preparation of nanocarriers. Particle size, surface charge, surface hydrophobicity and drug release are the main factors affecting nanoparticles physical stability and biological performance of the incorporated drug. In clinical practice, many nanodrugs have been used for both diagnostic and therapeutic applications and are being investigated for various indications in clinical trials. Nanoparticles are used for the cure of kidney diseases, tuberculosis, skin conditions, Alzheimer’s disease, different types of cancer as well as preparation of COVID-19 vaccines. Conclusion In this review, we will confer the advantages, types, methods of preparation, characterization methods and some of the applications of nano-systems.

Oral and Topical Anti-Inflammatory Activity of Jatropha integerrima Leaves Extract in Relation to Its Metabolite Profile

Jatropha integerrima Jacq., family: Euphorbiaceae, is used in India and subtropical Africa to treat different skin conditions. In this study we evaluated the anti-inflammatory activity of J. integerrima leaves extract (JILE) using rat paw edema model. The extract was administered orally (200 and 400 mg/kg) or applied topically as creams at 2.5, 5, and 10% strength. Four hours post-treatment, maximum reduction of edema volume by 63.09% was observed after oral administration of JILE (400 mg/kg) as compared to indomethacin with 60.43%. The extract anti-inflammatory effect was accompanied by a decrease in NO, prostaglandin PGE2, TNF-a and PKC levels by 19, 29.35, 16.9, and 47.83%, respectively. Additionally, topical applications of JILE showed dose dependent reduction in paw edema and resulted in normalized levels of PGE2, TNF-a, and PKC when used as 10% cream. Signs of inflammations were reduced or absent from paw tissue of animals receiving JILE either orally or topically. Finally, liquid chromatography/mass spectrometry analysis of JILE resulted in the annotation of 133 metabolites including 24 diterpenoids, 19 flavonoids, 10 phenolic acid conjugates, 8 cyclic peptides, 6 phytosterols, 4 sesquiterpenes, and 4 coumarins. Several of the annotated metabolites have known anti-inflammatory activity including vitexin, isovitexin, fraxitin, scopeltin, stigmasterol, and many diterpenoidal derivatives.

Nanocrystalline chloroxine possesses broad-spectrum antimicrobial activities and excellent skin tolerability in mice

Background: Antimicrobial submicrometer particles are being studied as promising interventions against a wide range of skin conditions, such as fungal or bacterial infections. Aims: To submicronize chloroxine, the crystalline compound 5,7-dichloro-8-hydroxyquinoline, by nanoprecipitation and characterize the resulting assemblies. Methods: The chloroxine particles were stabilized by a nonionic surfactant and were studied by a broth microdilution assay against 20 medically important bacteria and fungi. The intervention was studied using a murine model of skin irritation. Results & conclusions: Chloroxine nanoparticles with a diameter of 600–800 nm exhibit good tolerability in terms of skin irritation in vivo and good antimicrobial activity. Thus, the fabricated formulation shows great promise for interventions for both cutaneous infection control and prophylaxis.

Task shifting in dermatology: Are nurses prepared and willing?

Background: The high burden of skin diseases and the shortage of dermatologists are significant challenges in providing care to millions of people with skin diseases. Task shifting to nurses is a viable option for the delivery of dermatologic care in resource-poor settings. Satisfactory knowledge and a positive attitude are crucial for nurses to undertake the task of managing common skin diseases. This study aimed to investigate the knowledge of registered nurses and their attitude toward common skin conditions. Methods: In this descriptive, cross-sectional study, a total of 187 nurses were included from a nurses training institute by total enumeration sampling. A knowledge questionnaire and five-point Likert type-attitude scale were developed, validated, and employed to collect data. Written informed consent was obtained from the participants after approval from the institute ethics committee. Results: The mean of the knowledge scores were 10.7 ± 2.2. Nearly two thirds (62%) of the subjects demonstrated a low level of knowledge, while the remaining 38% showed a moderate level. There was no participant in the high-knowledge category. A majority of the nurses demonstrated a favorable attitude toward learning and undertaking the task of managing common skin conditions. Conclusion: We observed a low level of knowledge on diagnosing and managing common skin conditions. We recommend incorporating the relevant concepts of common skin conditions in the nursing curriculum with an emphasis on continuing education.

Strategies to Optimize Adherence in Patients with Mycosis Fungoides

Patient adherence to medications for common skin conditions has been extensively studied over the past two decades, and suboptimal adherence is a primary contributor to treatment failure. The impact of sub-par adherence in cutaneous T-cell lymphoma (CTCL) patients has been largely unexplored, and promoting adherence in this patient population may represent a promising area of consideration for improving treatment outcomes. We apply patient adherence strategies that have been studied in dermatology to CTCL and provide concrete examples of how these strategies can be used to improve adherence in the CTCL setting. Through the implementation of small changes in how we present and counsel about therapeutic options to our patients, we can maximize patient adherence, which has the potential to optimize therapy regimens and reduce treatment failure.

Skin-lightening practices in India

Skin lightening involves various practices to bleach the skin or to reduce the normal skin tone. The practice of skin-lightening spans several continents throughout the centuries and cultures primarily aimed at improving the quality of life. The main aim of skin lightening in medieval times was to increase the sign of femininity and thereby its benefits. In India, skin lightening is preferred as a mark of class, caste, and richness. Dermatologists are faced with many problems dealing with requests to make skin fairer, while in the west, there is a problem dealing with skin conditions in skin of color. Many skin-lightening agents are sold as over-the-counter products and are popularized or advertised through magazines, social media, and celebrity influences. These products are self-prescribed and used rampantly despite the side effects. There is a strong equation between caste, social class, marital prospects, and occupational status based on skin color. Multinational skin-lightening cosmetic brands have a lucrative market. The most widely used topical agent in skin lightening is hydroquinone, while other non-hydroquinone agents are also frequently used. In general, combining skin-lightening agents have increased efficacy. Systemic agents such as glutathione, tranexamic acid, Vitamin C, and other miscellaneous agents are also popular. Several procedures ranging from chemical peels to lights and lasers are increasingly practiced for more effective skin lightening. In India, all skin-whitening creams can be bought without a prescription as OTC products. These products are not considered pharmaceutical products and are not subject to testing and regulations. In addition, the injudicious use of intravenous glutathione by unqualified personnel poses a threat to the lay public. In our role as dermatologists, we should develop a holistic approach in counseling and treating those patients on a quest for skin lightening.