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Coimbatore, India

Varadharajulu S.,Senior Sleep Technologist | Chandrasekaran B.,PSG Hospitals
Indian Journal of Psychiatry

Periodic limb movements unlike restless leg syndrome is under diagnosed and unrecognized in medical arena. While robust Western trials have elucidated the association between periodic limb movements and sleep disturbances, it is not well received and recognized in India even in well sophisticated tertiary care hospital. We report a chronic insomnia patient who had sleep disturbances for past 30 years due to periodic limb movements alone. This was diagnosed through polysomnography. This case emphasizes monitoring leg movements during sleep study. This report may open new horizons in improving monitoring in sleep study in clinical setting. Source

Murthy M.S.,Vignan Institute of Pharmaceutical Sciences | Rajagopal K.,Zydus Cadila Healthcare | Nagaprabu V.N.,PSG Hospitals
Journal of Pharmacology and Pharmacotherapeutics

A patient suffering from rheumatoid arthritis who had extreme adrenal suppression as a result of chronic use of herbal medicines presented with complications of adrenal suppression such as muscle weakness. He also had psychiatric disturbances such as confusion and suicidal tendency. Steroids in the herbal medication were found and hence there exists a need for investigation into their safety and efficacy. Source

Lakshmi C.,PSG Hospitals | Krishnaswamy G.,PSG Hospitals
Indian Journal of Dermatology

Background: Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same. Aim: The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions. Materials and Methods: This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4-6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm 2. The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs. Results: After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos. Conclusion: Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals. © 2015 Indian Journal of Dermatology | Published by Wolters Kluwer - Medknow. Source

Srinivas C.,PSG Hospitals | Kumaresan M.,PSG Hospitals
Indian Journal of Dermatology, Venereology and Leprology

Introduction: Lasers are a good therapeutic tool for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. Machines: Among the various lasers used for treating vascular lesions, pulsed dye laser (PDL) has the best efficacy and safety data. The other machines that are widely available are Nd:YAG laser and intense pulse light (IPL). Rationale and scope of guideline: Much variation exists in different machines and techniques, and therefore, establishing standard guidelines has limitations. The guidelines recommended here indicate minimum standards of care for lasers on vascular lesions based on current evidence. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during post-graduation or later at a center that provides education and training in lasers, or in focused workshops, which provide such trainings. He/she should have adequate knowledge of the lesions being treated, machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician′s minor procedure room with adequate laser safety measures. Indications: PWS, hemangioma, facial telangiectasia, rosacea, spider angioma, pyogenic granuloma, venous lakes, leg veins. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases, and medical conditions. Relative: Unstable vitiligo, psoriasis, keloid and keloidal tendencies, patient on isotretinoin, patient who is not cooperative or has unrealistic expectation. Patient Selection: Patient selection should be done after detailed counseling with respect to the course of lesions, different treatment options, possible results, cost, need for multiple treatments, and possible postoperative complications. Treatment Sessions: The number of treatments per lesion varies from 2 to 12 or more at 6-8 week intervals. All lesions may not clear completely even after multiple sessions in many cases. Hence, a realistic expectation and proper counseling is very important. Laser parameters: Laser parameters vary with area, type of lesion, skin color, depth of the lesion, and machine used. A test spot may be performed to determine individual specifications. Complications: Pain, edema, purpura, bleeding, scarring, postinflammatory hyperpigmentation/ hypopigmentation, and atrophy changes. Source

Kumaresan M.,PSG Hospitals | Srinivas C.R.,PSG Hospitals
Indian Journal of Dermatology

Background: Intense pulsed light (IPL) has been used for the treatment of facial acne. Modifications of various parameters allow flexibility in treatment, which include energy fluence, pulse duration, and pulse delay. We compared the efficacy of burst-pulse (multiple pulse) mode with single-pulse mode in treatment of acne. Objective: This study was designed to evaluate the efficacy of the IPL in treatment of facial acne and to compare burst-pulse and single-pulse mode in treatment of acne. Materials and Methods: Ten patients with facial acne were subjected to monotherapy with IPL. Baseline grading of acne was done with Michelsons acne severity index; however, right and left side of face were scored separately and a total score was also taken. IPL was administered once weekly for four sessions. Right side was subjected to IPL with burst-pulse mode, and left side was subjected to single-pulse mode. Severity score assessed after the end of treatment. Clinical photographs were also obtained for evaluation. Results: All patients revealed a reduction in number of acne for both single- and burst-pulse mode treated sides. The mean total score was 49.4 at baseline and showed 49.19% reduction after four sessions of IPL. Burst-pulse mode treated side showed a better control than that of single-pulse mode. Conclusion: IPL as a monotherapy showed beneficial effect in treatment of facial acne. Burst-pulse mode was better than the single-pulse mode in clearing acne. Source

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