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   Table of Contents - Current issue
Coverpage
September-October 2016
Volume 82 | Issue 5
Page Nos. 475-598

Online since Thursday, August 04, 2016

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EDITORIAL  

Expanding our digital archives p. 475
M Ramam, Binod K Khaitan
DOI:10.4103/0378-6323.187720  PMID:27500563
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REVIEW ARTICLES Top

Livedoid vasculopathy: A review of pathogenesis and principles of management Highly accessed article p. 478
Biju Vasudevan, Shekhar Neema, Rajesh Verma
DOI:10.4103/0378-6323.183635  PMID:27297279
Livedoid vasculopathy is a rare cutaneous disease manifesting as recurrent ulcers on the lower extremities. The ulceration results in atrophic, porcelain white scars termed as atrophie blanche. The pathogenesis is yet to be understood with the main mechanism being hypercoagulability and inflammation playing a secondary role. The important procoagulant factors include protein C and S deficiency, factor V Leiden mutation, antithrombin III deficiency, prothrombin gene mutation and hyperhomocysteinemia. Histopathology of livedoid vasculopathy is characterized by intraluminal thrombosis, proliferation of the endothelium and segmental hyalinization of dermal vessels. The treatment is multipronged with anti-thrombotic measures such as anti-platelet drugs, systemic anticoagulants and fibrinolytic therapy taking precedence over anti-inflammatory agents. Colchicine, hydroxychloroquine, vasodilators, intravenous immunoglobulin, folic acid, immunosuppressive therapy and supportive measures are also of some benefit. A multidisciplinary approach would go a long way in the management of these patients resulting in relief from pain and physical as well as psychological scarring.
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Psoriasis and risk of incident atrial fibrillation: A systematic review and meta-analysis p. 489
Patompong Ungprasert, Narat Srivali, Wonngarm Kittanamongkolchai
DOI:10.4103/0378-6323.186480  PMID:27451924
Background and Objectives: Patients with psoriasis might have a higher risk of developing atrial fibrillation as a result of chronic inflammation. This study aimed to investigate this association by comprehensively reviewing all available evidence. Methods: We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, incidence ratio or standardized incidence ratio with 95% confidence intervals comparing the risk of incident atrial fibrillation in patients with psoriasis versus participants without psoriasis. Both retrospective and prospective cohort studies were eligible. Pooled risk ratio and 95% confidence intervals were calculated using random-effect, generic inverse variance methods of DerSimonian and Laird. Results: Three retrospective studies with 110,568 cases of psoriasis and 5,352,817 participants without psoriasis were included in this meta-analysis. The pooled risk ratio of subsequent development of atrial fibrillation in patients with psoriasis versus participants without psoriasis was 1.21 (95% confidence interval, 1.14–1.29). The statistical heterogeneity was low with an I2 of 29%. Limitations: Coding-based design of the primary studies that had limited accuracy. Conclusions: Our meta-analysis demonstrated a statistically significant increase in the risk of incident atrial fibrillation among patients with psoriasis.
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ORIGINAL ARTICLES Top

Evaluation of cervical and anal intraepithelial neoplasia in women attending a sexually transmitted infection clinic p. 498
Kavita Bisherwal, Deepika Pandhi, Archana Singal, Kiran Guleria, Kiran Mishra
DOI:10.4103/0378-6323.183634  PMID:27297278
Background: The incidence of anal and cervical cancers and their precursors have increased in the past decades. Women with HIV and sexually transmitted infections are at a higher risk. Cervical human papilloma virus infection may serve as a reservoir and source of anal infection or vice versa. A higher incidence of anal cytological abnormality has been observed in patients with abnormal cervical cytology. Objectives: This cross sectional study was designed to estimate the prevalence and associations of anal and cervical cytological abnormalities in a cohort of sexually active women using Papanicolaou smears. Methods: We conducted a single centre study of 35 consecutive HIV positive and 40 HIV negative women attending the sexually transmitted infection clinic. Cervical and anal specimens were obtained for cytology after a detailed history and examination. Chi square test and coefficient of correlation were used for comparison. Results: Cervical dysplasia was observed in 22.6% (17.3% low-grade squamous intraepithelial lesion and 5.3% high grade squamous intraepithelial lesion) and anal dysplasia in 8% study subjects (6.7% low-grade squamous intraepithelial lesion and 1.3% high grade squamous intraepithelial lesion); no association was observed with HIV infection. A higher number of patients with cervical dysplasia (29.4%) were found to have concomitant anal dysplasia (P = 0.002). History of anal intercourse was reported in all patients with anal dysplasia and was higher (P < 0.037) in patients with cervical dysplasia. Limitations: The limitations included a small sample size, lack of correlation with histological findings and bias due to STI clinic-based recruitment of the study population. Conclusion: Cytology may be used to screen for cervical and anal dysplasia in women irrespective of HIV status. Women with cervical dysplasia may be preferentially screened for anal dysplasia and vice versa. Anal intercourse may be a risk factor for anal and cervical dysplasia.
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Acyclovir is not effective in pityriasis rosea: Results of a randomized, triple-blind, placebo-controlled trial p. 505
Sanjay Singh, Anurag , Narendra K Tiwary
DOI:10.4103/0378-6323.182791  PMID:27212277
Background: Acyclovir is considered to be an effective treatment for pityriasis rosea but randomized, blinded, placebo-controlled trials have not been performed. Aims: To test the efficacy of acyclovir in pityriasis rosea in a randomized, triple–blind, placebo-controlled trial. Methods: Twenty seven patients with pityriasis rosea were randomly allocated to receive placebo (n = 13) or acyclovir (800 mg five times daily for one week) (n = 14). The severity of disease was assessed by the pityriasis rosea area and severity index. Cure was defined as the absence of erythema, with no or minimal scaling. Results: The number of days (mean ± standard deviation) taken for cure was not significantly different between the two groups (placebo 26.54 ± 9.14 days versus acyclovir 33.29 ± 9.49 days; P = 0.0720, t-test; 95% confidence interval of difference −0.65 to 14.14 days). Limitations: The sample size for the present study was calculated using data from an earlier study. As the standard deviation was not mentioned in that article, a common standard deviation of fifteen days was assumed. A study with a larger sample size may be more effective in detecting minor treatment differences between acyclovir and placebo, if they exist at all. Conclusion: Acyclovir is not an effective treatment for pityriasis rosea.
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Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study p. 510
Sunil K Kothiwala, Neena Khanna, Nikhil Tandon, Nitish Naik, Vinod K Sharma, Sanjeev Sharma, V Sreenivas
DOI:10.4103/0378-6323.183638  PMID:27297282
Background: Previous epidemiological studies suggest an association between psoriasis and metabolic syndrome and risk of subclinical atherosclerosis. However, there is a paucity of data in the Indian population on these associations. Objectives: To evaluate the prevalence of metabolic syndrome and subclinical atherosclerosis in patients with chronic plaque psoriasis compared to healthy controls and to correlate the prevalence of metabolic syndrome with severity of psoriasis. Methods: A hospital-based cross-sectional study was performed on 140 patients with chronic plaque psoriasis and 140 controls. Psoriasis was categorized as mild, moderate and severe based on psoriasis area and severity index (<10, 10–14 and ≥15, respectively) and as disease of short (<1 year), intermediate (1–3 years) and long duration (>3 years). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting bloaod sugar and lipid profile were estimated. Metabolic syndrome was diagnosed by the presence of 3 or more of the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. A subset of 30 psoriatic patients and 30 healthy controls were selected by the systematic sampling method for cardiac evaluation including electrocardiography, echocardiography and carotid intima-media thickness measurement. Results: The prevalence of metabolic syndrome was significantly more in psoriatic patients than in controls (39.3% vs. 17.1%, odds ratio = 3.13). Psoriatic patients also had a significantly higher prevalence of hypertension, abdominal obesity and diabetes. There was a significant trend to increase in prevalence of metabolic syndrome, hypertension and type 2 diabetes with increased severity and longer duration of the psoriasis. Patients with psoriasis had significantly higher carotid intima-media thickness (mean 0.61 mm ± 0.01 mm vs. 0.37 mm ± 0.01 mm) than controls. Limitation: This was a hospital-based cross-sectional study with a relatively small sample size. A prospective study with a larger sample would have validated the results further. Conclusion: There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to controls; the prevalence of metabolic syndrome and its components increases with severity and duration of psoriasis. There is a higher prevalence of subclinical atherosclerosis in patients with psoriasis thus increasing the risk of cardiovascular disease. We suggest that patients with moderate to severe psoriasis be screened routinely for metabolic syndrome and cardiovascular disease and encouraged to correct modifiable cardiovascular risk factors.
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BRIEF REPORT Top

Skin scrapings versus standardized skin surface biopsy to detect Demodex mites in patients with facial erythema of uncertain cause – a comparative study p. 519
Sumanas Bunyaratavej, Chuda Rujitharanawong, Pranee Kasemsarn, Waranya Boonchai, Chanai Muanprasert, Lalita Matthapan, Charussi Leeyaphan
DOI:10.4103/0378-6323.174423  PMID:26858058
Background: Standardized skin surface biopsy (SSSB) is considered to be the gold standard technique to evaluate the density of Demodex mites for the diagnosis of demodicidosis. Potassium hydroxide (KOH) preparation of skin scrapings is a much simpler procedure that can be used to detect pathogens in the superficial skin. Objective: To evaluate the reliability of potassium hydroxide preparation of skin scrapings as compared to the standard skin biopsy technique with regard to capacity to detect Demodex mites, time consumed and technician satisfaction. Methods: One hundred outpatients presenting with facial erythema of uncertain cause were enrolled. Standardized skin surface biopsy and potassium hydroxide preparation of skin scrapings were undertaken in adjacent areas on the patients' right cheek. Limitation: Patients with normal facial skin were excluded from the study. Results: The accuracy of Demodex mite detection by potassium hydroxide preparation of skin-scrapings when compared to the standard procedure is 82%. The sensitivity, specificity, positive and negative predictive values of this method are 75%, 84.2%, 60% and 91.43%, respectively. There was no statistically significant difference between the standard and skin scraping techniques (P = 0.238) with regard to mite detection. Mean preparation time while using the skin scraping technique was 6 times less than that of the standard technique. For interpretation also, skin scraping technique (3.6 min) consumed much less time than the biopsy technique (9.8 min). Moreover, experienced technicians were more satisfied with skin scraping. Conclusion: Potassium hydroxide preparation of skin scrapings is an effective, time saving and practical technique to detect Demodex mites with accuracy comparable to the standard biopsy method.
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CASE REPORT Top

Chlamydia trachomatis serovar G infection in a bisexual male with urethritis p. 523
Jyoti Rawre, Benu Dhawan, Karnika Saigal, Neena Khanna
DOI:10.4103/0378-6323.181470  PMID:27126261
We report a case of Chlamydia trachomatis serovar G urogenital tract infection in a 33-year-old human immunodeficiency virus-1 (HIV-1) seropositive Indian bisexual male. This case highlights the emergence of a new serovar in India. The patient was tested positive for C. trachomatis by both cryptic plasmid and omp A gene polymerase chain reaction (PCR). On further characterization using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) and omp A gene sequencing, the strain was found to be C. trachomatis serovar G. His spouse was also found to be infected with C. trachomatis serovar G. Phylogenetic analysis was performed on the clinical isolates obtained from both partners and were found to be identical to the isolates available in GenBank. The sexual network could not be traced further. Detection of a new genotype suggests importation of a new strain into the population probably by sexual contact with a person from a geographical area where the strain is common. Identifying circulating genotypes in the community can assist in developing strategies for improved sexually transmitted disease control.
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IMAGES IN CLINICAL PRACTICE Top

Isolated discoid lupus erythematosus of the lower eyelid p. 527
Nisha Vinod Parmar, Davinder Parsad, Uma Nahar Saikia
DOI:10.4103/0378-6323.171637  PMID:26658393
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PREVIOUSLY PUBLISHED ARTICLES Top

Clinical and epidemiological profile of sexually transmitted infections in a tertiary care centre in Kerala: A 1-year observational study p. 529
Bhushan Kumar
DOI:10.4103/0378-6323.183624  PMID:27297268
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Authors' reply p. 530
Jayasree Puravoor, Binitha P Manikoth, Najeeba Riyaz, Biju George
DOI:10.4103/0378-6323.185048  PMID:27500564
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LETTERS TO THE EDITOR - STUDY LETTER Top

Clinico-bacteriological study of pyodermas in a tertiary care centre in South India p. 532
Manju Mohan, EN Abdul Latheef, KL Sarada Devi, Najeeba Riyaz
DOI:10.4103/0378-6323.182793  PMID:27212278
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LETTERS TO THE EDITOR - CASE LETTERS Top

Kimura's disease in an old case of leprosy p. 535
Debeeka Hazarika, Nazneen Jahan, Anup Kumar Das
DOI:10.4103/0378-6323.182978  PMID:27241505
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Ichthyosis follicularis, atrichia and photophobia (IFAP) syndrome affecting two successive generations in an Indian family p. 537
Niharika Ranjan Lal, Debabrata Bandyopadhyay, Saheli Misra, Asim Kumar Sarkar, Sudhakar Rao
DOI:10.4103/0378-6323.182796  PMID:27212281
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Giant cell arteritis with extensive scalp necrosis: A diagnostic and therapeutic challenge p. 539
Diana Crisan, Lars Alexander Schneider, Sabine Kastler, Christina Psotta-Schachtner, Kerstin Gethöffer, Anca Sindrilaru, Karin Scharffetter-Kochanek
DOI:10.4103/0378-6323.182976  PMID:27241503
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Early-onset sarcoidosis and juvenile idiopathic arthritis:A diagnostic dilemma p. 542
Kumud Agarwal, Shyamanta Barua, Pankaj Adhicari, Seujee Das, Rebecca Marak
DOI:10.4103/0378-6323.183626  PMID:27297270
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Oleogranulomas of the breast treated with hydroxychloroquine p. 545
Ilteris Oguz Topal, Emek Kocaturk, Hatice Duman, Yunus Topal
DOI:10.4103/0378-6323.182973  PMID:27241500
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Adult orbital xanthogranulomatous disease: A case report and brief discussion of the terminology p. 547
Burak Tekin, Ilke Bahçeci Simsek, Reha Akpinar, Cuyan Demirkesen
DOI:10.4103/0378-6323.182974  PMID:27241501
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Retiform hemangioendothelioma: A rare entity at atypical site p. 550
Seema Rani, Jasmeet Singh, Arvind Kumar Ahuja, Minakshi Bhardwaj
DOI:10.4103/0378-6323.183633  PMID:27297277
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Porokeratotic eccrine ostial and dermal duct nevus: A report of three cases p. 553
Premanshu Bhushan, Sarvesh Sunil Thatte, Avninder Singh, Suhail Jayant
DOI:10.4103/0378-6323.183629  PMID:27297273
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Squamous cell carcinoma of the nail fold masquerading as pyogenic granuloma p. 555
Geeti Khullar, Saurabh Singh, Uma Nahar Saikia, Archit Kumar, Mini P Singh, Amrinder J Kanwar
DOI:10.4103/0378-6323.182975  PMID:27241502
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Primary subcutaneous hydatid cyst of the leg: An unusual location and review of the literature p. 558
Hamideh Moravvej, Hamid Reza Haghighatkhah, Fahimeh Abdollahimajd, Saeed Aref
DOI:10.4103/0378-6323.182807  PMID:27212285
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Metastatic Merkel cell carcinoma of the face p. 562
Mario Vaccaro, Emanuele Magaudda, Pina Brianti, Luana Licata, Roberta Cardia, Francesco Saverio De Ponte
DOI:10.4103/0378-6323.182795  PMID:27212280
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Harmful traditional healing practices in the treatment of lymphatic filariasis p. 565
Saravu R Narahari, Kadengodlu Manjula, Kuthaje S Bose, Madhur Guruprasad Aggithaya, Gaddam K Swamy, Terence J Ryan
DOI:10.4103/0378-6323.183631  PMID:27297275
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Multinucleated giant cells in angiolymphoid hyperplasia with eosinophilia p. 567
Manveen Kaur, Varsha Dalal, V Ramesh, Avninder Singh
DOI:10.4103/0378-6323.182977  PMID:27241504
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Pustular rheumatoid neutrophilic dermatitis with Koebner phenomenon p. 569
Kejin Zhang, Guizhi Zhou, Changping Yu, Keyu Wang, Furen Zhang
DOI:10.4103/0378-6323.183637  PMID:27297281
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Vitiligo-like lesions following imiquimod 5% application for condyloma acuminata: An additional case p. 572
Ismaël Maatouk
DOI:10.4103/0378-6323.182808  PMID:27212286
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Cutaneous sarcoidosis and macular amyloidosis occurring at the same site p. 574
Sanchita Karmakar, V Ramesh
DOI:10.4103/0378-6323.183627  PMID:27297271
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Bullous pemphigoid successfully treated with omalizumab p. 577
Müzeyyen Gönül, Havva Ozge Keseroglu, Can Ergin, Ibrahim Özcan, Özlem Erdem
DOI:10.4103/0378-6323.183628  PMID:27297272
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Successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole Highly accessed article p. 579
Kenit P Ardeshna, Shaurya Rohatgi, Hemangi R Jerajani
DOI:10.4103/0378-6323.183632  PMID:27297276
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IMAGES IN CLINICAL PRACTICE Top

Cutaneous metastasis as the primary manifestation of large cell neuroendocrine carcinoma of lung p. 583
Asli Akin Belli, Emine Dervis, Nazmi Geyik
DOI:10.4103/0378-6323.171008  PMID:26658387
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QUIZ Top

Multiple hypopigmented macules on the face p. 585
Asit Mittal, Chesta Agrawal, Manisha Balai, Rajiv Joshi
DOI:10.4103/0378-6323.184201  PMID:27320767
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E-IJDVL - NET STUDIES Top

Combined vitamin C sonophoresis and neodymium-doped yttrium aluminum garnet (NdYAG) laser for facial hyperpigmentation: An outcome observation study in Asian patients p. 587
Yu-Tsung Chen, Chang-Cheng Chang, Cherng-Ru Hsu, Jen-Hsiang Shen, Chao-Jen Shih, Bor-Shyh Lin
DOI:10.4103/0378-6323.182806  PMID:27212284
Background: The neodymium-doped yttrium aluminum garnet (NdYAG) laser therapy has been a popular technique for facial rejuvenation but certain adverse effects like post-inflammatory hyperpigmentation are issues of concern to Asian patients. Aims: To assess the outcome following combined treatment with vitamin C sonophoresis and NdYAG laser, in selected cases of facial hyperpigmentation. Methods: Twenty three women with dyschromia or melasma who had undergone five sessions of Q-switched NdYAG laser therapy followed by transdermal delivery of vitamin C via sonophoresis were selected after a retrospective review of case records. The objective and subjective clinical outcomes and the side effects, including erythema, scaling, pruritus, dryness and post-inflammatory hyperpigmentation were evaluated. Results: In both objective or subjective outcomes, 91.3% (21/23) of the patients showed an excellent or better outcome, while 8.7% (2/23) showed no change. A majority of the patients (73.9%, 17/23) experienced no post-inflammatory hyperpigmentation or had slight post-inflammatory hyperpigmentation which quickly resolved within 1 week. Only one (4.3%) patient had extreme post-inflammatory hyperpigmentation which lasted for over a month. Limitations: This was a retrospective study without a control group; a comparative study with a control group (patients treated with the laser alone, without vitamin C sonopheresis) is needed to determine the difference in the outcome. Conclusion: The use of vitamin C sonophoresis along with NdYAG laser may reduce the incidence of adverse effects in Asian patients. Patients experienced obvious improvement in hyperpigmentation and had lower chances of experiencing extreme or severe post-inflammatory hyperpigmentation.
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Effects of isotretinoin on the thyroid gland and thyroid function tests in acne patients: A preliminary study p. 587
Belkiz Uyar, Aynur Solak, Ali Saklamaz, Muhittin Akyildiz, Berhan Genç, Ayse Gökduman
DOI:10.4103/0378-6323.182794  PMID:27212279
Background: Isotretinoin is widely used in the treatment of acne. Aims: We investigated the effects of isotretinoin on thyroid function tests and thyroid volume in acne patients. Methods: In this prospective study, a total of 104 acne patients were included. Sixty-six patients were treated with isotretinoin for at least 4 months. Thirty eight patients were included in the control group. The levels of thyroid stimulating hormone, free triiodothyronine, free thyroxine, antithyroglobulin and antithyroid peroxidase antibodies were measured and a thyroid ultrasound was performed in all the subjects before treatment and 4 months after treatment. A “p” value of < 0.05 was considered significant. Results: In the isotretinoin-treated group, thyroid stimulating hormone levels increased significantly during isotretinoin treatment (P = 0.018). Free triiodothyronine, free thyroxine, anti-thyroid peroxidase levels and thyroid volume decreased significantly during treatment (P = 0.016, P= 0.012, P= 0.006, P = 0.020 respectively). Limitations: The major limitation of this study is the lack of follow-up data after the cessation of isotretinoin therapy in acne patients. Conclusion: Patients treated with isotretinoin should be monitored with thyroid function tests.
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E-IJDVL - NET LETTER Top

Angioma serpiginosum: A case series of 4 patients p. 588
Premanshu Bhushan, Sarvesh Sunil Thatte, Avninder Singh
DOI:10.4103/0378-6323.182972  PMID:27241499
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RESIDENTS CORNER Top

Viva questions from the IJDVL p. 589
Vishalakshi Viswanath, Resham Vasani
DOI:10.4103/0378-6323.187773  
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BOOK REVIEWS Top

Manual of Dermatological Differential Diagnosis p. 595
M Manjunath Shenoy
DOI:10.4103/0378-6323.187717  
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Comprehensive approach to infections in dermatology p. 596
VK Jain
DOI:10.4103/0378-6323.187718  
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OBITUARY Top

Kshitish Chandra Saha (January 1, 1930 – June 3, 2016) p. 597
AK Hati
DOI:10.4103/0378-6323.187719  PMID:27500565
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Online since 15th March '04
Published by Wolters Kluwer - Medknow