Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

2020 ◽  
Vol 14 (2) ◽  
pp. 87-90
Author(s):  
Sadaf Amin Chaudhry ◽  
Nadia Ali Zafar ◽  
Rabia Hayat ◽  
Ayesha Noreen ◽  
Gulnaz Ali ◽  
...  
Keyword(s):  
Side Effects ◽  
Therapeutic Option ◽  
Acne Vulgaris ◽  
Treatment Options ◽  
Tertiary Care ◽  
Poor Response ◽  
Global Assessment Scale ◽  
Severe Acne ◽  
Hematologic Profile

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated. Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks. Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile. Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

scholarly journals Standard daily dosage versus pulse dosage of Isotretinoin in acne vulgaris: A hospital based comparative study

2018 ◽  
Vol 7 (2) ◽  
pp. 68-74
Author(s):  
Eliz Aryal ◽  
SB Shrestha ◽  
G Pokhrel ◽  
S Bhattarrai
Keyword(s):  
Side Effects ◽  
Comparative Study ◽  
Acne Vulgaris ◽  
College Teaching ◽  
Poor Response ◽  
Lumbosacral Spine ◽  
Daily Regimen ◽  
Severe Acne ◽  
Pulse Dose ◽  
Oral Isotretinoin

Background: Acne is a multi factorial disease ranging from a couple of comedones and pustules to severe nodulocystic fulminantacne. Isotretinoin (13-cis-retinoic-acid) drug affect all the factors involved in pathogenesis of acne and approved by Food and Drug Administration in 1982. It causes several dose-dependent mucocutaneous and systemic side effects and cost effectObjective: To assess and compare the efficacy and tolerability of two regimens (daily conventional and pulse dose) in moderate to severe acne vulgaris.Methodology: This is a prospective randomized comparative study in moderate to severe acne vulgaris in Kathmandu Medical College Teaching Hospital. The patients were randomly divided into two groups (A and B). In group A conventional dose of 20 mg of oral isotretinoin was given daily and in group B 20 mg of oral isotretinoin was given thrice (Pulse Dosage in alternate day) in a week for six months. The baseline haematological, biochemical and radiological (lumbosacral spine) was compare on first, third and six month.Results: Seventy-four patients were enrolled with mean age of 21.73 years. Patients with daily regimen show good response throughout the therapy for six months (1st, 3rd 6th months), where as those in pulse therapy show moderate to poor response during early month and gradually improve by end of sixth month. At end of sixth month, both the regimen show good response and was statistically significant.Conclusion: However, the pulse dose regimen makes the treatment more acceptable, for patients with acne than the classical standard daily regimen, in term of side effects and cost effectiveness and patient compliance. Journal of Kathmandu Medical CollegeVol. 7, No. 2, Issue 24, Apr.-Jun., 2018, Page: 68-74

Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne

2013 ◽  
Vol 17 (2) ◽  
pp. 114-122 ◽  
Author(s):  
Gordon W. Jung ◽  
Jennifer E. Tse ◽  
Isabella Guiha ◽  
Jaggi Rao
Keyword(s):  
Side Effects ◽  
Therapeutic Option ◽  
Acne Vulgaris ◽  
Antibiotic Use ◽  
Vaginal Candidiasis ◽  
Lesion Count ◽  
Open Label ◽  
Group B ◽  
Systemic Antibiotics

Background: Systemic antibiotics are an effective treatment for acne vulgaris. However, intolerable side effects may invariably occur. Objective: To determine whether probiotics reduce the side effects imparted by systemic antibiotics while working synergistically with the latter in treating inflammatory acne. Methods: Forty-five 18- to 35-year-old females were randomly assigned to one of three arms in this prospective, open-label study. Group A received probiotic supplementation, whereas group B received only minocycline. Group C was treated with both probiotic and minocycline. Clinical and subjective assessments were completed at baseline and during the 2-, 4-, 8-, and 12-week follow-up visits. Results: All patients demonstrated a significant improvement in total lesion count 4 weeks after treatment initiation ( p < .001), with continued improvement seen with each subsequent follow-up visit ( p < .01). At the 8- and 12-week follow-up visits, group C had a significant decrease in total lesion count versus groups A ( p < .001) and B ( p < .01). Two patients (13%) from group B failed to complete the study secondary to vaginal candidiasis. Conclusion: Probiotics may be considered a therapeutic option or adjunct for acne vulgaris by providing a synergistic antiinflammatory effect with systemic antibiotics while also reducing potential adverse events secondary to chronic antibiotic use.

scholarly journals Efficacy and outcome of Microneedling (Dermaroller) in post-acne scars

2021 ◽  
Vol 7 (3) ◽  
pp. 256-259
Author(s):  
Lalitha C ◽  
Leelavathy B ◽  
Shwetha S
Keyword(s):  
Therapeutic Option ◽  
Acne Vulgaris ◽  
Treatment Options ◽  
Cost Effective ◽  
Psychological Trauma ◽  
Acne Scar ◽  
Severe Acne ◽  
Delayed Treatment ◽  
Type Iv ◽  
Acne Scars

Acne vulgaris is a common dermatological disorder affecting teenagers and young adults with the consequence of scarring. As acne is considered as a normal occurrence and neglected or delayed treatment of severe acne lead to cosmetically disfiguring scarring leading to much psychological trauma to youngsters. Acne scarring can be atrophic or hypertrophic. There are multitude of treatment options for atrophic acne scars like dermabrasion, chemical peels and lasers. But these cosmetic procedures are have drawbacks like requiring fine skills and long downtime (dermabrasion), or expensive for most of the population(laser). Microneedling using dermaroller is an inexpensive safe therapeutic option for the Indian skin type with less complication. The aim of this study was to evaluate the efficacy of microneedling (dermaroller) in different types of atrophic acne scar and it’s complications.A descriptive study was performed using 30 patients with atrophic acne scar treated with microneedling for a period of two years. Details of duration, site, type and depth of acne scar along with skin types was recored. Patients were given dermaroller treatment for 4 session, each spaced at one month interval and results assessed at the end of each session and at end of six months. In this study, 30 patients with atrophic acne scars of grade 2 and 3 were treated with microneedling therapy and efficacy and complication of this therapy were evaluated. These patients had all three types of atrophic scars- rolling, ice- pick and boxcar, these 27 patients showed 50 % improvement in their scar score at the end of the study (6 months). Among above mentioned scar types, rolling and boxcar scar showed improvement by 47.42% and 65.40% respectively at the end of the study, whereas ice-pick scars showed no significant improvement. According to the modified acne scar scoring system, 55.6% of the patients had improvement in their scar scoring between 41 and 50% (good response) and 44.4 % had improvement of more than 50 % (very good response). All patients were satisfied with the outcome of the procedure.Microneedling is a safe, cost effective, innovative procedure in the treatment armamentarium of acne scars without major complications. This is found to be safe to use in Fitzpatrick type IV and V scars. However, further studies are necessary to validate these findings.

Chemo-prophylaxis of COVID-19 with hydroxychloroquine: a study of health care workers attitude, adherence to regime and toxicities/side effects (Preprint)

2020 ◽  
Author(s):  
Debajyoti Bhattacharyya ◽  
Neeraj Raizada ◽  
Bharathnag Nagappa ◽  
Arvind Tomar ◽  
Prateek Maurya ◽  
...  
Keyword(s):  
Side Effects ◽  
Health Care Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Perceived Threat ◽  
Care Hospital ◽  
Care Workers ◽  
Perceived Danger ◽  
Structured Questionnaire

BACKGROUND There are apprehensions among healthcare worker (HCWs) about COVID-19. The HCWs have been given hydroxychloroquine (HCQ) chemo-prophylaxis for seven weeks as per Government of India guidelines. OBJECTIVE To assess the apprehensions among HCWs about COVID-19 and to document accessibility, adherence and side effects related to HCQ prophylaxis in HCWs. METHODS A longitudinal follow up study was conducted in a tertiary care hospital. HCQ was given in the dose of 400 mg twice on day one, and then 400 mg weekly for seven weeks. 391 HCWs were interviewed using semi structured questionnaire. RESULTS 62.2% HCWs expressed perceived danger posted by COVID-19 infection. Doctors (54%) showed least acceptance and paramedics (88%) showed highest acceptance to chemo-prophylaxis. 17.5% participants developed at least one of the side effects to HCQ. Females and nursing profession were significantly associated with adverse effects. Common side effects were gastro-intestinal symptoms, headache and abnormal mood change. Most of these were mild, not requiring any intervention. Gender, professions and perceived threat of COVID-19 were significantly associated with acceptance and adherence to HCQ prophylaxis. CONCLUSIONS Two third of HCWs had perceived danger due to COVID-19. Three fourth of the HCWs accepted chemo-prophylaxis and four out of five who accepted had complete adherence to prophylaxis schedule. One out of five had developed at least one of side effects; however, most of these were mild not requiring any intervention.

scholarly journals Side effects of the metacognitive training for depression compared to a cognitive remediation training in patients with depression

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mona Dietrichkeit ◽  
Marion Hagemann-Goebel ◽  
Yvonne Nestoriuc ◽  
Steffen Moritz ◽  
Lena Jelinek
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Statistical Power ◽  
Controlled Trial ◽  
Treatment Options ◽  
Cognitive Remediation ◽  
Negative Effects ◽  
Metacognitive Training ◽  
To Receive

AbstractAlthough awareness of side effects over the course of psychotherapy is growing, side effects are still not always reported. The purpose of the present study was to examine side effects in a randomized controlled trial comparing Metacognitive Training for Depression (D-MCT) and a cognitive remediation training in patients with depression. 84 patients were randomized to receive either D-MCT or cognitive remediation training (MyBrainTraining) for 8 weeks. Side effects were assessed after the completion of each intervention (post) using the Short Inventory of the Assessment of Negative Effects (SIAN) and again 6 months later (follow-up) using the Negative Effects Questionnaire (NEQ). D-MCT and MyBrainTraining did not differ significantly in the number of side effects. At post assessment, 50% of the D-MCT group and 59% of the MyBrainTraining group reported at least one side effect in the SIAN. The most frequently reported side effect was disappointment in subjective benefit of study treatment. At follow-up, 52% reported at least one side effect related to MyBrainTraining, while 34% reported at least one side effect related to the D-MCT in the NEQ. The most frequently reported side effects fell into the categories of “symptoms” and “quality”. Our NEQ version was missing one item due to a technical error. Also, allegiance effects should be considered. The sample size resulted in low statistical power. The relatively tolerable number of side effects suggests D-MCT and MyBrainTraining are safe and well-received treatment options for people with depression. Future studies should also measure negative effects to corroborate our results.

scholarly journals IV Paracetamol for closure of patent ductus arteriosus in preterm neonates admitted to a tertiary care centre

2018 ◽  
Vol 5 (2) ◽  
pp. 294 ◽  
Author(s):  
Sunil B. ◽  
Shruthi Patel ◽  
Girish N.
Keyword(s):  
Side Effects ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Tertiary Care ◽  
Current Treatment ◽  
Preterm Neonates ◽  
Tertiary Care Centre ◽  
Vascular Connection ◽  
Intravenous Paracetamol

Background: Ductus arteriosus is a vascular connection between the pulmonary artery and descending aorta. The incidence is inversely related to birth weight and gestational age (GA). In preterm infants it varies between 40% and 60% on the third day of life. At present, the choice of treatment of clinically significant PDA is with either ibuprofen or indomethacin, but they carry many contraindications and potential side effects. Hence it is important to consider that paracetamol may be used as an alternative to other non steroidal anti-inflammatory drugs and is effective in ductal closure with minimal side effects.Methods:Thirty six preterm infants with hemodynamically significant PDA(hs-PDA) were treated with intravenous paracetamol and subsequent closure was evaluated clinically and by follow-up 2D-Echo.Results: PDA closure following intravenous paracetamol was evident in 27 babies (75%). There were no significant side effects noted with paracetamol therapy.Conclusions: This study shows that paracetamol could offer favourable safety profile in comparison to current treatment options. Therefore, paracetamol may be accepted as a first-line drug treatment for PDA in preterm infants. 

Global impact of a clinical informatics system: Scalable delivery of on-time access to evidence-based multidisciplinary expert treatment decisions for all cancers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6502-6502 ◽  
Author(s):  
Rajendra A. Badwe ◽  
Pramesh CS ◽  
Sudeep Gupta ◽  
Nita S. Nair ◽  
Nancy Renee Feldman ◽  
...  
Keyword(s):  
Developing Countries ◽  
Treatment Options ◽  
Tertiary Care ◽  
Treatment Decisions ◽  
Evidence Based ◽  
Expert Opinions ◽  
Informatics System ◽  
The World ◽  
Simple Language

6502 Background: There is a scarcity of expert oncologists in the world. Patients in nonurban areas have poor access to evidence-based treatment decisions and worse outcomes. In India, there are ~1600 experts for 1.8 Million patients. Created in May 2014, “TMC NCG Navya Online” is an expert opinion service based on an informatics system. We prospectively study its real-world impact. Methods: Navya exhaustively searches and outputs evidence and experience based treatment options for an individual patient. Its accuracy was validated in trials at TMC (one of the world’s largest tertiary care centers) and UCLA-OVMC. Navya’s patient data summary and treatment options are rapidly reviewed and vetted (1-2 minutes) on mobile by experts from TMC and NCG, (consortium of 104 cancer centers in India). Expert decisions are converted into a simple language report for patients. System generated evidence based information on diagnostics, regimens, side effects etc are also provided. To prospectively assess impact, from July to December 2016, all patients were asked via phone follow-up: 1. If report was shared with treating provider, 2. Final treatments delivered. Results: 9361patients from 22 developing countries registered with TMC NCG Navya Online. 3402 expert decisions were provided and converted into 2614 simple language reports. 5229 patients received system generated evidence based information. Median time to deliver a report was 24 hours. The prospective sample was 582 decisions with a 75% (n = 436) follow-up rate. 74% of reports were shared with treating providers. 73% of TMC NCG Navya’s decisions, (n = 306), were the final treatments delivered. Common reasons for non-implementation included decline in ECOG status and not testing biomarkers (ER/PR etc). Conclusions: Expert oncologists use Navya to provide rapid online opinions to patients across 22 developing countries. Patients shared the expert opinions with their providers and received evidence-based treatments. Expanding the reach and impact of such a service to nonurban USA and the world, can maximize outcomes for patients without ready access to expertise.

Levetiracetam monotherapy for treatment of structural epilepsy in dogs: 19 cases (2010–2015)

2017 ◽  
Vol 181 (15) ◽  
pp. 401-401 ◽  
Author(s):  
Darren Kelly ◽  
Francesca Raimondi ◽  
Nadia Shihab
Keyword(s):  
Side Effects ◽  
Seizure Control ◽  
Case Series ◽  
Poor Response ◽  
Response To Treatment ◽  
Seizure Freedom ◽  
Retrospective Case ◽  
Cluster Seizures ◽  
Structural Epilepsy

To evaluate the efficacy and tolerability of levetiracetam monotherapy in dogs with structural epilepsy. Retrospective case series. Nineteen client-owned dogs with structural epilepsy. Seizure frequencies after initiation of treatment were used to evaluate the efficacy of levetiracetam monotherapy. Seizure control was considered good if no seizures occurred within three months of starting treatment or poor if seizures returned within one month of starting treatment. Tolerability was evaluated by considering the occurrence and severity of any reported side effects. Ten of the 19 dogs were considered to have a good response to treatment with 7 achieving complete seizure freedom. Nine dogs were considered to have poor response to treatment. There was a statistically significant reduction in the percentage of patients experiencing cluster seizures from 68.4% to 15.8% (p=0.002). Side effects were noted in 8 of the 19 dogs but were considered mild in all cases. Follow-up times ranged from 12 days to 426 days. When used in conjunction with other appropriate therapies, levetiracetam may be an efficacious option for monotherapy in dogs with structural epilepsy. Its tolerability makes it a suitable option for use in a wide variety of patients.

scholarly journals Comparative evaluation of two commonly administered regimens of mifepristone and misoprostol for first trimester abortion

2018 ◽  
Vol 7 (7) ◽  
pp. 2759
Author(s):  
L. Thulasi Devi ◽  
Ravi Nimonkar
Keyword(s):  
Side Effects ◽  
Tertiary Care Hospital ◽  
Randomized Study ◽  
Tertiary Care ◽  
First Trimester ◽  
Family Welfare ◽  
Care Hospital ◽  
Trimester Abortion ◽  
Misoprostol Group

Background: The objective of this study was to compare and evaluate the efficacy of two commonly administered regimens as per existing guidelines of Ministry of Health and Family Welfare for Outpatient MTP services. This study is aimed at evaluation of subjective and objective stastical benefits and side effects in performance of first trimester abortion on OPD basis in popularly used drugs as advised by MOHFW by different routes of administration. The drugs used were Tab Mifepristone (RU – 486) and Tab Misoprostol.Methods: This prospective randomized study was conducted in Out Patient Department of Obstetrics and Gynaecology in a tertiary care hospital over a period of 1 year after due clearance was obtained from Ethical Committee. This was prospective study involving 400 ladies reporting for Outpatient MTP services within the given time period as per existing guidelines at a tertiary care hospital. Patients were assessed at the end of 7, 15and 56 days, the mean age of the patients was 24.5±0.5 and 33±1 years and treatment duration was an average of 3 days with follow up for 15 days post administration. Few cases of failure required a follow up of approximately 56 days. All patients were on follow up for a period of 3 months for determination of menstrual irregularities and contraception management.Results: Between the 2 groups, in the sublingual Misoprostol group 100% aborted successfully at the end of 56 days. Whereas in the vaginal Misoprostol group 99% aborted successfully at the end of 56 days, only two patients requiring MVA as an OPD procedure.Conclusions: Patients were assessed at the end of 7, 15 and 56 days and between both the groups; Mifepristone with administration of misoprostol sublingually showed better success rate in completion of procedure, quicker action with better patient satisfaction and acceptance compared to conventional administration of Mifepristone and vaginal administration of misoprostol. Misoprostol administered sublingually under medical supervision is a superior, faster abortificient and has lesser incidence of Retained Products of Conception (RPOC) or need for Suction & Evacuation (S&E) as compared to vaginal route. Side effects observed need more evaluation with larger sample size to be statistically significant.

scholarly journals Assessing of the Risk Factor & Determine Epidemiology of Acne Vulgaris in Tertiary Care Teaching Hospital

2021 ◽  
pp. 261-271
Author(s):  
Rajesh Hadia ◽  
Idrisi Mohammed Tousif ◽  
Avani Kapadia ◽  
Suchitra Pillai ◽  
Hemraj Singh Rajput ◽  
...  
Keyword(s):  
Acne Vulgaris ◽  
Seborrheic Dermatitis ◽  
Tertiary Care ◽  
Study Data ◽  
Cross Sectional ◽  
Severe Acne ◽  
Factor Determine ◽  
History Of ◽  
The Common ◽  
Social Habits

Background: Acne vulgaris remains one of the commonest diseases to afflict humanity, with over 90% of males and 80% of females affected by the age of 21 years. Objectives: The aim of this study was to assessing the specific risk factors, determine the epidemiology and etiology of Acne Vulgaris. Methodology: It is a cross-sectional observational study conducted for a period of six month in the department of dermatology, Dhiraj General Hospital, Vadodara. Patients who were diagnosed with acne vulgaris and fulfilled the inclusion criteria were enrolled in the study. Data was collected by filling the patient medical record sheet. Result: Total 300 patients were included in the study. Out of which 38.67% males and 61.33% females were found affected by Acne Vulgaris. The mean age group affected were found to be 21.77±4.06 years. When compared their social habits, patients consumed more caffeine (49.67%) than alcohol (24.67%), smoking (15.33%) and tobacco (5.67%). 32.33% patients also had history of seborrheic dermatitis. Using GAGS scale, we found 94% patients suffered from moderate Acne condition while 6% suffered from severe Acne condition. Conclusion: Acne Vulgaris was predominantly found in females in adolescence and in males in adulthood. The severity was found more in males than females. The common site for Acne Vulgaris was found to be face while comedones and papules were the common types of lesions. Stress was found to be one of the major aggravating factors for severity of Acne Vulgaris.

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