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   Table of Contents - Current issue
Coverpage
January-February 2017
Volume 83 | Issue 1
Page Nos. 1-151

Online since Friday, December 02, 2016

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EDITORIALS  

Concluding remarks Highly accessed article p. 1
M Ramam
DOI:10.4103/0378-6323.195073  
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Global leprosy strategy 2016–2020: Issues and concerns p. 4
P Narasimha Rao
DOI:10.4103/0378-6323.195075  
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VIEW POINT Top

Do we really need sunscreens? Highly accessed article p. 7
Atul Taneja, Asit Mittal, Ranjana Beniwal
DOI:10.4103/0378-6323.194290  
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REVIEW ARTICLES Top

Topical peptides as cosmeceuticals p. 9
Varadraj Vasant Pai, Prasana Bhandari, Pankaj Shukla
DOI:10.4103/0378-6323.186500  
Peptides are known to have diverse biological roles, most prominently as signaling/regulatory molecules in a broad variety of physiological processes including defense, immunity, stress, growth, homeostasis and reproduction. These aspects have been used in the field of dermatology and cosmetology to produce short, stable and synthetic peptides for extracellular matrix synthesis, pigmentation, innate immunity and inflammation. The evolution of peptides over the century, which started with the discovery of penicillin, has now extended to their usage as cosmeceuticals in recent years. Cosmeceutical peptides may act as signal modulators of the extracellular matrix component, as structural peptides, carrier peptides and neurotransmitter function modulators. Transdermal delivery of peptides can be made more effective by penetration enhancers, chemical modification or encapsulation of peptides. The advantages of using peptides as cosmeceuticals include their involvement in many physiological functions of the skin, their selectivity, their lack of immunogenicity and absence of premarket regulatory requirements for their use. However, there are disadvantages: clinical evidence for efficacy is often weak, absorption may be poor due to low lipophilicity, high molecular weight and binding to other ingredients, and prices can be quite high.
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Nail tic disorders: Manifestations, pathogenesis and management p. 19
Archana Singal, Deepashree Daulatabad
DOI:10.4103/0378-6323.184202  
Nail tic disorders are classic examples of overlap between the domains of dermatology and psychiatry. They are examples of body-focused repetitive behaviors in which there is an irresistible urge or impulse to perform a certain behavior. The behavior is reinforced as it results in some degree of relief and pleasure. Nail tic disorders are common, yet poorly studied and understood. The literature on nail tic disorders is relatively scarce. Common nail tics include nail biting or onychophagia, onychotillomania and the habit tic deformity. Some uncommon and rare nail tic disorders are onychoteiromania, onychotemnomania, onychodaknomania and bidet nails. Onychophagia is chronic nail biting behavior which usually starts during childhood. It is often regarded as a tension reducing measure. Onychotillomania is recurrent picking and manicuring of the fingernails and/or toenails. In severe cases, it may lead to onychoatrophy due to irreversible scarring of the nail matrix. Very often, they occur in psychologically normal children but may sometimes be associated with anxiety. In severe cases, onychotillomania may be an expression of obsessive-compulsive disorders. Management of nail tic disorders is challenging. Frequent applications of distasteful topical preparations on the nail and periungual skin can discourage patients from biting and chewing their fingernails. Habit-tic deformity can be helped by bandaging the digit daily with permeable adhesive tape. Fluoxetine in high doses can be helpful in interrupting these compulsive disorders in adults. For a complete diagnosis and accurate management, it is imperative to assess the patient's mental health and simultaneously treat the underlying psychiatric comorbidity, if any.
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ORIGINAL ARTICLES Top

Topical sirolimus for the treatment of angiofibromas in tuberous sclerosis p. 27
Salih Levent Cinar, Demet Kartal, Ayşe Kacar Bayram, Mehmet Canpolat, Murat Borlu, Ayten Ferahbas, Hüseyin Per
DOI:10.4103/0378-6323.190844  
Background: The skin is one of the most affected organs in tuberous sclerosis complex and angiofibromas are seen in almost 80% of such patients. These benign tumors impose a great psycho-social burden on patients. Objective: The aim of the study was to evaluate the effectiveness and tolerability of topical sirolimus for facial angiofibromas in patients with tuberous sclerosis complex. Methods: This was a prospective, single-blinded, cross-over study which involved twelve patients. We investigated the effect and safety of topical 0.1% sirolimus, which was obtained by crushing sirolimus tablets and mixing it with petrolatum. The patients were asked to apply the cream to one side of their face, and vaseline to the other side. The effect of topical sirolimus was evaluated using the “facial angiofibroma severity index.” Results: There was a significant improvement in the redness and extension of the tumors on the sides to which the active ingredient was applied. Some side effects such as itching and irritation occurred in three patients, which were treated with topical hydrocortisone cream. Conclusion: Topical sirolimus appears to be a promising, fairly well tolerated treatment for facial angiofibromas in patients with tuberous sclerosis complex. Although its efficacy diminishes with time, repetitive usage is effective.
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Pyoderma gangrenosum: A clinico-epidemiological study p. 33
Najeeba Riyaz, Vineetha Mary, Sarita Sasidharanpillai, Riyaz A Roshin, Ottakandathil Snigdha, Ettappurath N. Abdul Latheef, Saleem Rahima, Valiaveetil Bindu, Ravindran N Anupama, Deepthi N Sureshan, Pentam Veil Beegum Sherjeena
DOI:10.4103/0378-6323.188654  
Background: Pyoderma gangrenosum is a neutrophilic dermatosis of unknown etiology, with inconstant systemic associations and a variable prognosis. Aims: To study the clinical features and systemic associations of pyoderma gangrenosum and its response to treatment. Methods: All patients diagnosed to have pyoderma gangrenosum at the dermatology department of the Government Medical College, Kozhikode, from January 01, 2005 to December 31, 2014 were included in this prospective study. Results: During the 10-year study period, 61 patients were diagnosed to have pyoderma gangrenosum. A male predilection was noted. The most common clinical type was ulcerative pyoderma gangrenosum (90.2%). More than 60% of patients had lesions confined to the legs; 78.7% had a single lesion and 27.9% had systemic associations. Most patients required systemic steroids. Patients with disease resistant to steroid therapy were treated with intravenous immunoglobulin G and split-thickness skin grafts under immunosuppression induced by dexamethasone pulse therapy. All except one patient attained complete disease resolution. Limitations: The main limitation of our study was the small sample size. Conclusions: The male predilection documented by us was contrary to most previous studies. We found split-thickness skin graft to be a useful option in resistant cases. More prospective studies may enable the formulation of better diagnostic criteria for pyoderma gangrenosum and improve its management.
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A study of the free radical scavenging effects of Piper betle leaf extract in patients with vitiligo p. 40
Sneha Mitra, Ayan Kumar Pati, Alak Manna, Arghyaprasun Ghosh, Sumit Sen, Suparna Chatterjee, Mitali Chatterjee
DOI:10.4103/0378-6323.187688  
Background: Vitiligo is an idiopathic skin disease manifested by depigmented macules. It is characterised by melanocyte destruction, and redox imbalance is proposed to play a contributory role. Aim: The aim of this study was to analyze the effects of an ethanolic extract of Piper betle leaves on the generation of reactive oxygen species in erythrocytes sourced from vitiligo patients. Methods: The effect of Piper betle on the generation of reactive oxygen species in erythrocytes was measured by flow cytometry in patients with active and stable vitiligo versus healthy controls, using 5-(and-6)-chloromethyl-2'-7'-dichlorodihydrofluorescein diacetate. Results: The generation of reactive oxygen species in erythrocytes was higher in patients with vitiligo (n = 23) compared to healthy controls (n = 18). The geometrical mean fluorescence channel was 23.05 ± 2.11 in patients versus 17.77 ± 1.79 in controls, P = 0.039. The levels of reactive oxygen species were higher in patients with active vitiligo. Treatment of erythrocytes with Piper betle in concentrations of 0.5 and 1.0 μg/ml significantly decreased the baseline levels of reactive oxygen species by 31.7% in healthy controls, and 47.6% and 44.3% in patients with active vitiligo, respectively. Piper betle effectively scavenged hydrogen peroxide, which was evident by a decrease in the geometrical mean fluorescence channel by 52.4% and 62.9% in healthy controls, and 45.0% and 57.0% in patients with active vitiligo. Limitations: The study had a small sample size. Future studies should focus on evaluation of the antioxidant role of Piper betle at the lesional site. Conclusion: This pilot study indicates that patients with active vitiligo demonstrate enhanced generation of reactive oxygen species in erythrocytes, which was significantly reduced following ex vivo treatment with Piper betle.
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Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: A randomized controlled open-label, evaluator-blinded study p. 47
Sujit J.S Shanshanwal, Rachita S Dhurat
DOI:10.4103/0378-6323.188652  
Background: Finasteride and dutasteride are inhibitors of the enzyme 5-alpha-reductase which inhibits the conversion of testosterone to dihydrotestosterone. Dutasteride inhibits both type I and type II 5-alpha-reductase while finasteride inhibits only the type II enzyme. As both isoenzymes are present in hair follicles, it is likely that dutasteride is more effective than finasteride. Aims: To compare the efficacy, safety and tolerability of dutasteride and finasteride in men with androgenetic alopecia. Methods: Men with androgenetic alopecia between 18 and 40 years of age were randomized to receive 0.5 mg dutasteride or 1 mg finasteride daily for 24 weeks. The primary efficacy variables were hair counts (thick and thin) in the target area from modified phototrichograms and global photography evaluation by blinded and non-blinded investigators. The secondary efficacy variable was subjective assessment using a preset questionnaire. Patients were assessed monthly for side effects. Results: Ninety men with androgenetic alopecia were recruited. The increase in total hair count per cm[2] representing new growth was significantly higher in dutasteride group (baseline- 223 hair; at 24 weeks- 246 hair) compared to finasteride group (baseline- 227 hair; at 24 weeks- 231 hair). The decrease in thin hair count per cm[2] suggestive of reversal of miniaturization was significantly higher in dutasteride group (baseline- 65 hair; at 24 weeks- 57 hair) compared to finasteride group (baseline- 67 hair; at 24 weeks- 66 hair). Both the groups showed a similar side effect profile with sexual dysfunction being the most common and reversible side effect. Limitations: Limitations include the short duration of the study (6 months), the small sample size and the fact that it was an open-label study. Conclusions: Dutasteride was shown to be more efficacious than finasteride and the side-effect profiles were comparable.
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CASE REPORT Top

Tumor necrosis factor-alpha inhibitors for the treatment of psoriasis patients with liver cirrhosis:A report of four cases with a literature review p. 55
Tulin Ergun, Dilek Seckin-Gencosmanoglu, Andac Salman, Zuleyha Ozgen, Esra Sarac Ocak, Erol Avsar, Nese Imeryuz
DOI:10.4103/0378-6323.186498  
Patients with psoriasis are at an increased risk of developing liver disease due to various factors. The existing data regarding the treatment of psoriasis patients with associated liver cirrhosis is limited. We report four patients of psoriasis with liver cirrhosis who were treated with TNF-alpha inhibitors for a mean duration of 35.4 months. Two patients were treated with etanercept, one with adalimumab and one was treated with both infliximab and etanercept. Three patients tolerated the treatment well without any deterioration of liver disease whereas one died of progressive liver disease. Although large-scale, controlled studies are needed, this case series provides insights regarding the long-term safety of TNF-alpha inhibitors in patients with psoriasis and liver cirrhosis.
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BRIEF REPORT Top

Ultraviolet A1 phototherapy: One center's experience p. 60
Sasi Kiran Attili, Robert S Dawe, Sally H Ibbotson
DOI:10.4103/0378-6323.182805  
Background: Ultraviolet A1(UVA1) phototherapy is increasingly being used in the treatment of morphea, atopic dermatitis, lupus and some other recalcitrant dermatoses. We present a retrospective review of our experience with this modality. Aim: To evaluate the treatment response rates for various dermatoses and adverse effects of UVA1 phototherapy. Methods: We reviewed phototherapy notes along with electronic and/or paper case records for all patients treated with UVA1 phototherapy from October 1996 to December 2008. Results: A total of 269 patients (outcomes available for 247) had 361 treatment courses (treatment data available for 317 courses) over this period. We found phototherapy to be beneficial in 28 (53%) of 53 patients with atopic dermatitis and 19 (51%) of 37 patients with morphea. A beneficial outcome was recorded in all six (100%) cases of urticaria and six (85.7%) of seven patients treated for a polymorphic light eruption. Benefit was also recorded in systemic lupus erythematosus (8 (44.4%) of 18), lichen sclerosus (6 (42.9%) of 14), mastocytosis (2 (33.3%) of 6), necrobiosis lipoidica (4 (30.8%) of 13), granuloma annulare (2 (25%) of 8), scleroderma (2 (22.2%) of 9) and keloids (1 (7.7%) of 13). Overall, treatment was well tolerated with no patients having to stop treatment due to adverse effects. Limitations: This is a retrospective study with no control group. Subjective/recall bias is quite possible as a number of patients were followed up over the phone. Conclusions: Our data suggest that ultraviolet A1 can be considered for the treatment of selected dermatoses. However, long-term malignancy risk is as yet unknown.
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IMAGES IN CLINICAL PRACTICE Top

Giant porokeratosis with overlying cutaneous horn and squamous cell carcinoma p. 66
Rajesh Kumar Mandal, Anupam Das, Piyush Kumar
DOI:10.4103/0378-6323.183625  
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES Top

Isotretinoin may affect pharmacokinetics of itraconazole in the skin: Is it rational to combine both for the treatment of dermatophytosis? p. 68
Ankita Srivastava, Sunil Kumar Kothiwala
DOI:10.4103/0378-6323.194292  
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Author's reply p. 69
Kenit P Ardeshna, Shaurya Rohatgi, Hemangi R Jerajani
DOI:10.4103/0378-6323.195074  
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LETTERS TO THE EDITOR - CASE LETTERS Top

Scedosporiosis presenting with subcutaneous nodules in an immunocompromised patient p. 71
Honghua Hu, Jisu Chen
DOI:10.4103/0378-6323.193624  
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Subungual angioleiomyoma p. 74
Daisuke Watabe, Eiichi Sakurai, Shiho Mori, Toshihide Akasaka
DOI:10.4103/0378-6323.185045  
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Paraffinoma of the penis and scrotum (sclerosing granuloma of the male genitalia) p. 75
Mercedes Alcalde-Alonso, Francisco Javier Velasco-Albendea, Agustín Soto-Díaz, Pilar Gómez-Avivar, Francisco Javier Torres-Gómez
DOI:10.4103/0378-6323.190889  
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Disseminated Kaposi's sarcoma in a human immunodeficiency virus-infected homosexual Indian man p. 78
Riti Bhatia, Shweta Shubhdarshini, Savita Yadav, M Ramam, Shipra Agarwal
DOI:10.4103/0378-6323.193612  
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Primary cutaneous plasmablastic lymphoma presenting as perineal ulcero-proliferative growth in a human immunodeficiency virus-seropositive patient p. 83
Biswanath Behera, Rashmi Kumari, Laxmisha Chandrashekar, Devinder Mohan Thappa, Rakhee Kar, Nachiappa Ganesh Rajesh
DOI:10.4103/0378-6323.192953  
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Uncombable hair syndrome with a woolly hair nevus p. 87
Suchetha Subba Swamy, BC Ravikumar, KN Vinay, DP Yashovardhana, Archit Aggarwal
DOI:10.4103/0378-6323.191133  
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Disseminated cryptococcosis presenting as cellulitis p. 89
Geo Han, Seung Hwi Kwon, Hae Jun Song, Jiehyun Jeon
DOI:10.4103/0378-6323.192959  
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Mucocutaneous leishmaniasis with marked facial disfigurement p. 91
Ozlem Ekiz, Şerif Şamil Kahraman, Bilge Bülbül Şen, Gamze Serarslan, Emine Nur Rifaioğlu, Gülnaz Culha, Tümay Özgür
DOI:10.4103/0378-6323.190848  
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Sub-block level monitoring in leprosy programme: Need of the hour p. 94
Dhananjay P Katkar, Suhas B Kadam, Balu N Mote, Ambadas S Adhav
DOI:10.4103/0378-6323.191131  
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A novel KRT6A mutation in a case of pachyonychia congenita from India p. 95
Anup Kumar Tiwary, Neil J Wilson, Mary E Schwartz, Frances J.D Smith
DOI:10.4103/0378-6323.193620  
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Cutaneous epithelioid angiomatous nodule versus epithelioid hemangioma: A dilemma p. 99
Divya Gupta, Rashmi Kumari, Sajini Elizabeth Jacob, Nachiappa G Rajesh, Devinder Mohan Thappa
DOI:10.4103/0378-6323.192960  
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Cutaneous toxicity of a new BRAF inhibitor, LGX818 (encorafenib) p. 102
Leire Loidi Pascual, Raquel Santesteban Muruzàbal, Maria Laura Álvarez Gigli, Juan Ignacio Yanguas Bayona
DOI:10.4103/0378-6323.191130  
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B-cell chronic lymphocytic leukemia followed by mycosis fungoides in a psoriatic patient on long-term methotrexate therapy p. 104
Mariem Mohamed, Mouna Korbi, Monia Youssef, Adnène Moussa, Adnène Laatiri, Hichem Belhadjali, Jameleddine Zili
DOI:10.4103/0378-6323.192954  
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Non-pigmenting fixed drug eruption due to fluoroquinolones p. 108
Lalit Kumar Gupta, Ranjana Beniwal, Ashok Kumar Khare, Asit Mittal, Sharad Mehta, Manisha Balai
DOI:10.4103/0378-6323.190890  
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LETTERS TO THE EDITOR - STUDY LETTERS Top

The utility of etanercept in chronic stable plaque psoriasis: Results from an open-label, prospective, single arm study p. 113
Anandan Venkatesan, KP Saradha, V Senthil Kumar, Mani Surya Kumar, C Zohra Begum, Rashmi Singh
DOI:10.4103/0378-6323.193613  
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Tuberculosis with atypical manifestations involving multiple sites of the oral cavity: A case study p. 116
Xuefeng Zhang, Jiongke Wang, Yuanqin Wu, Lu Jiang, Yu Zhou, Qianming Chen, Xin Zeng
DOI:10.4103/0378-6323.184200  
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LETTERS TO THE EDITOR - THERAPY LETTER Top

Iontophoresis with topical 0.05% tretinoin for the management of recalcitrant palmar psoriasis: A report of two cases p. 119
Aditya Kumar Bubna
DOI:10.4103/0378-6323.193614  
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Nano-silver dressing in toxic epidermal necrolysis p. 121
Shekhar Neema, Manas Chatterjee
DOI:10.4103/0378-6323.192955  
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IMAGES IN CLINICAL PRACTICE Top

Pearly penile papules p. 125
Sewon Hwang, Gyong Moon Kim
DOI:10.4103/0378-6323.190869  
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RESIDENTS PAGE Top

Intralesional drug therapy in dermatology Highly accessed article p. 127
Nitika S Deshmukh, Vasudha A Belgaumkar, Chandrakant B Mhaske, Bhavana R Doshi
DOI:10.4103/0378-6323.190870  
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QUIZ Top

Chronic subcutaneous nodules, plaques and ulcers of the hand p. 133
Aylin Türel Ermertcan, Nuri Özkütük, Peyker Temiz, Cengiz Çavuşoğlu, Süheyla Sürücüoğlu
DOI:10.4103/0378-6323.187092  
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E-IJDVL - NET LETTERS Top

Progressive Nagashima-type palmoplantar keratosis in a Chinese patient with recurrent c.796C>T mutation in SERPINB7 p. 136
Meng Qiu, Xian-Biao Zou
DOI:10.4103/0378-6323.187093  
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Acral syringomas associated with hematological neoplasm p. 136
Eduardo Varas-Meis, Camino Prada-García, Elia Samaniego-González, Manuel-Ángel Rodríguez-Prieto
DOI:10.4103/0378-6323.192961  
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Lip swelling: An unusual presentation of post kala-azar dermal leishmaniasis p. 136
Piyush Kumar, Abhijeet Jha, Anupam Das
DOI:10.4103/0378-6323.192957  
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RESIDENTS CORNER Top

Viva questions from the IJDVL p. 137
Vishalakshi Viswanath, Resham Vasani
DOI:10.4103/0378-6323.195077  
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BOOK REVIEW Top

Hair Transplantation p. 144
Savita Yadav
DOI:10.4103/0378-6323.194294  
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RETRACTION Top

Retraction: Delleman syndrome: Report of a case in an adolescent boy Highly accessed article p. 145

DOI:10.4103/0378-6323.191911  PMID:27779142
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ANNOUNCEMENT Top

IJDVL Awards 2016 p. 151
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Online since 15th March '04
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