Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept.
To compare ...the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma.
It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared.
Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later).
Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma.
In the wake of any disaster, communication plays a significant role in attaining the objective of Build Back Better; to provide accurate and timely information to the affected communities, enhance ...awareness and extend outreach of authorities. Although communication channels, media and tools pave the way to eliminate information gaps at different levels of the process, not all of them work effectively. This paper explores the channels, media and tools used for communication during the reconstruction of private houses after the 2015 Gorkha earthquake in Nepal, their effectiveness in providing quality information to the beneficiaries and its correlation with reconstruction outcome of construction time period. With aid of both qualitative and quantitative methodological approaches, three target groups (beneficiary, implementation and policy levels) were surveyed. Convenience sampling method was used to collect the data of beneficiary level survey where structured telephone interview was conducted among 274 earthquake reconstruction program beneficiaries of four earthquake affected districts; Kathmandu, Dhading, Nuwakot and Dolakha. Purposive sampling method was used to collect data from implementation and policy level respondents using web based survey. Results revealed that communication channels varied differently among different target groups, based on their role in reconstruction, level of education and accessibility. Where beneficiaries perceived to have received information regarding reconstruction on time and clearly, the time taken to complete construction had significantly decreased. Thus, to increase communication and outreach, understanding the diversity of target groups at different levels and usage of multiple media tools and channels is important. Comprehensive communication strategies and programs with ample resources, especially at the local and community levels for local mass media and person-to-person information sharing is crucial to disseminate information to end-users on time. This, followed by adequate monitoring for quality assurance and credibility aids the post-disaster reconstruction of private households in an owner driven reconstruction approach.
•Different target groups receive and perceive information differently.•Person-to-person communication must be recognized as an essential tool.•Higher variety of channels must be used in post-disaster recovery communication.•Beneficiaries with a better perception of quality information reconstructed faster.•A robust monitoring mechanism is essential to ensure qualitative information.
Background Lichen planus pigmentosus (LPP) is considered a chronic and progressive variant of lichen planus. Although pigmentation occurs in the sun exposed areas, the etiology remains unknown and ...there are no appropriate treatment guidelines. Association with thyroid disorder has been described in various disorders of pigmentation. Objective The objective of this study was to find the association between LPP and thyroid dysfunction. Method A total of 54 clinically diagnosed cases of LPP and 54 age and sex matched healthy control volunteers were included in this case control study. Thyroid function test and thyroid peroxidase antibody were analysed to determine the probable association between thyroid diseases and LPP. Result Seventeen (31.7%) patients had biochemical evidence of hypothyroidism and 3 had hyperthyroidism among the diseased group. Among the control group two persons were tested positive for hypothyroidism (c2 = 0.34; p <0.05). Similarly, the levels of thyroid peroxidase antibody in the LPP patients were found to be significantly higher than those of controls (p <0.05). Conclusion Thyroid disorder was found to be an associated factor in LPP. Hence, we recommend routine thyroid function tests in patients with LPP. Further research is warranted among large number of patients to elucidate the exact association.
Hormones, particularly androgens play a vital role in hair growth, differentiation and distribution. Hirsutism is a common entity among Nepalese population with skin types III, IV and V. Long pulsed ...lasers are commonly used for hair removal.
This is a prospective analytical study done in Dhulikhel Hospital Kathmandu University Hospital, Kavre, Nepal from November 2010 to November 2011. Patients were first subjected to hormonal evaluation. Androgens, their tropic hormones, insulin resistance markers and endocrine components were measured and compared. Subjects were then categorized into two groups according to androgen levels: group A (n=30) with significantly high androgen (total testosterone and dehydroepiandrosterone sulfate) or elevated luteinizing hormone: follicle stimulating hormone ratio, consistent with Polycystic Ovarian Syndrome (PCOS) and group B (n=30). Adrenal tumour was ruled out in all patients. All patients received long pulse Nd-YAG laser (50J/cm²; 50 msec pulse duration) therapy at four weeks interval to achieve at least 50% hair reduction.
Among group A patients, average 8.1 treatment sessions were required for substantial hair reduction, whereas, average 5.7 sessions produced similar results in group B patients (p-value <0.05).
Patients with high androgen level and elevated LH: FSH ratio requires more treatment sessions for hair removal with long pulsed ND-YAG laser than patients with normal or low hormone level.
Nepalese population with Fitzpatrick skin types III-V has high prevalence of pigmentary disorders and it is a growing cosmetic concern. Q-Switched Neodymium- Doped Yttrium Aluminum Garnet (QS Nd-YAG) ...laser is an efficacious tool in the treatment of pigment disorders.
To highlight the efficacy and safety profile of various pigment disorders.
A prospective study done in Dhulikhel Hospital, Kathmandu University Hospital from January 2009 to January 2011. Patients undergoing laser for pigmented skin lesions were followed for response and safety profile. We included total 270 patients in the study with various disorders especially nevus, tattoos and melasma. Settings were repeated at 3-4 weeks interval and response was evaluated on clinical basis. Efficacy was then evaluated according to various parameters.
For nevus, total 840 treatment sessions had been performed with an average of 6.88 sessions (range 3-11). Nd: YAG laser was very efficacious in removal of blue and black colored tattoos with an average of 7.9 and 9.5 sessions respectively. However, red mixed with blue and or green tattoos were relatively resistant to treatment and required average 10.33 treatment sessions. Melasma and freckles both responded to the therapy but recurrence rate was high.
Our results indicate that QS Nd: YAG laser is an effective modality for pigment disorders among Nepalese population. Nevus and melasma respond well but recurrence rate of melasma is high. Blue tattoos respond well while mixed colored tattoos are quite resistant to Nd: YAG laser alone. Transient pain and temporary hyperpigmentation are common side effects.
The burden of sexually transmitted infections is huge and is disproportionately affecting developing nations. In Nepal, recent available data on sexually transmitted infections are mostly targeted to ...high risk population. A prevalence study was thus done to explore the pattern of sexually transmitted infection syndromes among general population of Nepal.
To highlight the prevalence and changing pattern of sexually transmitted infections among general population.
A retrospective study. The study was conducted among 145 patients attending Department of Dermatology and Venerology, Dhulikhel Hospital Kathmandu University Hospital, for voluntary counseling and testing from April 2010 to April 2011. Syndromic case management approach was used for the classification and treatment of the patients.
106 patients were suffering from Sexually Transmitted Infections and 2 patients were positive for Human Immunodeficiency Virus. The most common diagnosis was genital viral infections (41.7%). Prevalence was highest among drivers/conductors (26.9%) and migrating workers (23.1%). Age group 20 to 24 years was the maximum sufferers (37%). Unsafe sexual activity (66.7%) was the most potential exposure and majority of the patients were not consistent in using condom.
Genital viral infections constitute the major bulk of sexually transmitted infections. Majority of the patients suffering from sexually transmitted infections were in the age group 20 to 24 years and were mostly drivers, conductors or migrating workers by occupation. In the background of few available baseline data, the results are expected to assist successful target interventions in the near future.
The LUX-ZEPLIN (LZ) experiment will enable a neutrinoless double β decay search in parallel to the main science goal of discovering dark matter particle interactions. We report the expected LZ ...sensitivity to Xe136 neutrinoless double β decay, taking advantage of the significant (>600 kg) Xe136 mass contained within the active volume of LZ without isotopic enrichment. After 1000 live-days, the median exclusion sensitivity to the half-life of Xe136 is projected to be 1.06×10^{26} years (90% confidence level), similar to existing constraints. We also report the expected sensitivity of a possible subsequent dedicated exposure using 90% enrichment with Xe136 at 1.06×10^{27 }years.
LUX-ZEPLIN (LZ) is a next-generation dark matter direct detection experiment that will operate 4850 feet underground at the Sanford Underground Research Facility (SURF) in Lead, South Dakota, USA. ...Using a two-phase xenon detector with an active mass of 7 tonnes, LZ will search primarily for low-energy interactions with weakly interacting massive particles (WIMPs), which are hypothesized to make up the dark matter in our galactic halo. In this paper, the projected WIMP sensitivity of LZ is presented based on the latest background estimates and simulations of the detector. For a 1000 live day run using a 5.6-tonne fiducial mass, LZ is projected to exclude at 90% confidence level spin-independent WIMP-nucleon cross sections above 1.4×10-48 cm2 for a 40 GeV/c2 mass WIMP. Additionally, a 5σ discovery potential is projected, reaching cross sections below the exclusion limits of recent experiments. For spin-dependent WIMP-neutron(-proton) scattering, a sensitivity of 2.3×10-43 cm2 (7.1×10-42 cm2) for a 40 GeV/c2 mass WIMP is expected. With underground installation well underway, LZ is on track for commissioning at SURF in 2020.
Deep underground environments are ideal for low background searches due to the attenuation of cosmic rays by passage through the earth. However, they are affected by backgrounds from γ-rays emitted ...by 40K and the 238U and 232Th decay chains in the surrounding rock. The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a liquid xenon TPC located within the Davis campus at the Sanford Underground Research Facility, Lead, South Dakota, at the 4850-foot level. In order to characterise the cavern background, in-situ γ-ray measurements were taken with a sodium iodide detector in various locations and with lead shielding. The integral count rates (0–3300 keV) varied from 596 Hz to 1355 Hz for unshielded measurements, corresponding to a total flux from the cavern walls of 1.9±0.4 $γ$ cm-2s-1. The resulting activity in the walls of the cavern can be characterised as 220±60 Bq/kg of 40K, 29±15 Bq/kg of 238U, and 13±3 Bq/kg of 232Th.
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