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C R Srinivas

Publications and source records attributed to C R Srinivas.

66 records · Page 4Linked to original sources

Journal club: screen, select, probe & evaluate.

Postgraduate dermatology training programs like seminars, panel discussions, and case presentations help residents to acquire knowledge. Journal club (JC) exercises help residents to update themselves with the current literature. What article a resident should choose and how a resident should evaluate and analyze an article or critically appraise a topic are issues that are most relevant for the success of a JC. Little guidance is available in the biomedical literature on how to deal with such issues. The objective of this article is to provide guidance to neophytes on dealing with JC exercises in a way that helps them in learning the critical appraisal skills. A review of the literature and of the author's experience in JC exercises will be presented. Knowing the methodology of rapid screening of articles along with the art of evaluating them, coupled with a sound knowledge of epidemiology and bio-statistics, helps a resident to select appropriate articles and discard poorly conceived or designed topics that may not generate interest in JC attendees. Hence, such an approach helps the resident in acquiring new knowledge in the shortest time. Choosing the right topic and then applying the newly obtained information to clinical practice, participants succeed in making the JC a valuable learning experience. Further, such well-formatted JCs help residents to improve the quality of health care delivered to patients.

Dermatology↗

Cutaneous manifestations in patients with chronic renal failure on hemodialysis.

BACKGROUND: Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. AIM: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. RESULTS: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%), followed by pallor (60%), pruritus (53%) and cutaneous pigmentation (43%). Other cutaneous manifestations included Kyrle's disease (21%); fungal (30%), bacterial (13%) and viral (12%) infections; uremic frost (3%); purpura (9%); gynecomastia (1%); and dermatitis (2%). The nail changes included half and half nail (21%), koilonychia (18%), onychomycosis (19%), subungual hyperkeratosis (12%), onycholysis (10%), splinter hemorrhages (5%), Mees' lines (7%), Muehrcke's lines (5%) and Beau's lines (2%). Hair changes included sparse body hair (30%), sparse scalp hair (11%) and brittle and lusterless hair (16%). Oral changes included macroglossia with teeth markings (35%), xerostomia (31%), ulcerative stomatitis (29%), angular cheilitis (12%) and uremic breath (8%). Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi's sarcoma were also observed. CONCLUSIONS: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.

Adolescent↗

Achieving asepsis of banana leaves for the management of toxic epidermal necrolysis.

BACKGROUND: Banana leaf is used in many centers in India during the care of patients with toxic epidermal necrolysis (TEN) and other extensive blistering disorders. Sepsis is an important cause of death in TEN patients and use of banana leaf may be a source of such infection. AIMS: We conducted this study to detect the bacterial flora of the banana leaf and to examine various methods of rendering the leaf aseptic. METHODS: Five pieces of banana leaf, 2 x 2 cm in size, were cultured separately in blood agar as follows: One piece was heated over a flame and one was soaked in boiling water and one was autoclaved. Methylated spirit was applied over one piece and ignited. One piece was placed on the media, 'as is.' The Petri dishes were incubated examined after 48 h. RESULTS: All the pieces except the autoclaved specimen of the leaf grew coagulase-negative staphylococci (CONS) when aseptic precautions were not maintained and aerobic spore bearers when all aseptic measures were subsequently instituted during the procedure. CONCLUSION: We recommend measures to prevent possible transmission of bacterial infection by the leaf. Autoclaved and aseptically handled banana leaves may be used to reduce chance of infection in the treatment of TEN.

Asepsis↗

Study of histamine wheal suppression by dexamethasone with and without iontophoresis.

BACKGROUND: Iontophoresis increases the penetration of drugs into the skin by electric current. The ability of topical steroids to reduce the size of the histamine wheal was used to assess the efficacy of topical dexamethasone delivered with and without iontophoresis. AIM: To determine the wheal suppressing ability of dexamethasone delivered with and without iontophoresis. METHODS: A template with three squares of 3x3 cm was placed on both forearms of 20 volunteers and the edges marked. A gauze piece soaked in 2 ml of dexamethasone solution was placed on the flexor aspect of the left forearm and the electrode, an aluminum foil was placed on it and connected to the negative pole (since dexamethasone is negatively charged). An electric current was passed for 15 minutes. Similarly, on the right forearm, a dexamethasone soaked gauze piece was placed without iontophoresis. Histamine wheal suppression was assessed at the end of 30 min, 1 hr and 2 hrs, on both sides. Statistical analysis was done using an independent t-test. RESULTS: There was a statistically significant difference in wheal suppression at 30 min (p=0.006) on the left hand where iontophoresis was used. CONCLUSION: Our experiment showed that topical dexamethasone with iontophoresis has the maximum effect at the end of 30 minutes and is more effective than dexamethasone without iontophoresis.

Administration, Topical↗

Exploiting the igloo principle and greenhouse effect to regulate humidity and temperature.

BACKGROUND: Toxic epidermal necrolysis can be fatal and nursing care with careful monitoring of temperature and humidity can improve survival rate. We adapted the greenhouse and igloo principle using a common hood to monitor the temperature and humidity. METHODS: A small heater with a regulator was placed in a mini hood and temperature was recorded inside the uncovered hood and hood covered with green cloth and aluminium foil separately. The regular hood was placed over a volunteer and the temperature was measured inside the open hood and hood covered with green cloth and aluminium foil separately. The relative humidity was also monitored using Zeal mercury dry--wet bulb hygrometer. RESULTS: Temperature increase was most marked in the foil-covered hood followed by cloth-covered hood, both with the heater and the volunteer. Similarly, in the volunteer study, the humidity was best maintained inside the aluminium foil-covered hood. CONCLUSION: We recommend the use of regular hood with suitable cover to monitor the humidity and temperature of patients with toxic epidermal necrolysis.

Body Temperature↗

Ninhydrin sweat test in leprosy.

Loss of sensation is an important feature of leprosy. Loss of sweating over the affected site due to loss of autonomic function occurs in leprosy. We have studied a simple, non-invasive, rapid method, using 1% ninhydrin in acetone, to detect loss of sweat function. The test was effective in detecting and grading the sweat function in 84 cases of different types of leprosy. We were able to detect normal sweating in 16 patients with hypopigmented lesion due to causes other than Hansen's disease.

Autonomic Nervous System Diseases↗

Histiocytic lymphoma simulating lepromatous leprosy--a case report.

Histiocytic lymphomas are known to begin with skin lesions and remain localised to the skin for months or years before visceral involvement becomes evident. We report a case of nodular histiocytic lymphoma with clinical features simulating lepromatous leprosy.

Adult↗

Thickening of peripheral nerves in neurofibromatosis.

A rare case of multiple neurofibromatosis (von Recklinghausen's Disease) with bilateral, uniform and gross enlargement of peripheral nerves simulating nerve thickening in leprosy is reported. The case also showed characteristic palmar melanotic macules.

Adult↗