Which Cut-offs for Secondary V[Combining Dot Above]O2max Criteria Are Robust to Diurnal Variations?

Purpose The aim was to determine the minimum secondary exhaustion criteria cut-offs (i.e. max respiratory exchange ratio [RERmax], max heart rate [HRmax], max rating of perceived exertion [RPEmax], and max blood lactate concentration [BLmax]) necessary to determine maximum oxygen uptake (VO2max) during cardiopulmonary exercise tests (CPET), by balancing type I and type II errors. A further aim was to investigate if the defined cut-offs would be robust to diurnal and to day-to-day variations. Methods Data from two CPET studies involving young athletes were analyzed. In the first study, 70 male participants performed one CPET until exhaustion to define cut-offs. In the second study, eight males and five females performed one CPET on seven consecutive days at six different times of day (i.e., diurnal variation). The time of the CPET was identical on the sixth and seventh days (i.e., day-to-day variation). To ensure comparability both studies were carried out under the same conditions. Results Participants' mean VO2max was 63.0 ± 5.3 ml/kg/min. RERmax ≥ 1.10 was reached by 100%, HRmax ≥ 95% of age predicted maximum heart rate by 99%, RPEmax ≥ 19 by 100%, and BLmax ≥ 8 mmol/l by 100% of participants, respectively. Regarding the intra-day variations, latter cut-offs were not reached in two cases for RERmax and in one case for HRmax and BLmax. Intraclass correlations for the day-to-day variability were r = 0.823 for RERmax, r = 0.828 for HRmax, and r = 0.380 for BLmax, respectively. Conclusions High cut-off values for secondary exhaustion criteria need to be used to determine VO2max in athletes. Address for Correspondence: Dr. Raphael Knaier, Departement für Sport, Bewegung und Gesundheit, Universität Basel, Birsstrasse 320B, 4052 Basel, Switzerland; E-Mail: raphael.knaier@unibas.ch, Phone: +41-612074710, Fax: +41-612074742. This study was not funded. None of the authors involved in the present study have any conflict of interest, financial, personal, or otherwise, that would influence this research, and the results do not constitute endorsement by the American College of Sports Medicine. The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 10 December 2018. © 2018 American College of Sports Medicine

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Acute Effects of Exercise Intensity on Insulin Sensitivity under Energy Balance

Exercise is known to improve insulin sensitivity (SI), however studies to date have been confounded by negative energy deficits following exercise. Purpose The primary objective of this study was to assess the effect of 8-16 weeks of aerobic exercise training on the SI of untrained women under rigorously controlled energy balanced conditions. The secondary objective was to determine if one acute bout of moderate (MIC)- or high (HII)-intensity exercise further affected SI. Methods SI was assessed in 28 untrained women at baseline, following 8-16-weeks of training with no-exercise prior to assessment (NE), 22hrs after MIC (50% VO2peak), and 22hrs after HII (84% VO2peak) using a hyperinsulinemic-euglycemic clamp. Participants were in a whole-room indirect calorimeter during each condition and food intake was adjusted to ensure energy balance across 23 hours prior to each clamp. Results There were no significant differences in acute energy balance between each condition. Results indicated a significant main effect of time, such that SI was higher during the HII condition compared to both baseline and NE (P

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Essentials of Biostatistics in Public Health, 3rd Edition

No abstract available

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Aftereffects of Cognitively Demanding Acute Aerobic Exercise on Working Memory

Purpose This study examined the aftereffects of cognitively demanding acute aerobic exercise on working memory in middle-age individuals. Methods In a within-participants design, middle-age males (n = 28) performed a two-back task to assess working memory before, immediately after, and 30 min after the following three interventions: 1) a rest-cognition intervention, in which they performed a cognitive task on a cycle ergometer without exercising; 2) an exercise-cognition intervention, in which they simultaneously exercised on a cycle ergometer and performed a cognitive task; and 3) an exercise-only intervention, in which they only exercised on a cycle ergometer. Results The exercise-only intervention resulted in increased hit rate and decreased reaction times and intraindividual variability on correct rejection trials, suggesting that simple aerobic exercise had a beneficial impact on working memory. By contrast, the exercise-cognition intervention resulted in increased intraindividual variability on correct rejection trials, which is suggestive of cognitive fatigue resulting from the additional cognitive demands. Such a decline was not observed even in the rest-cognition condition. Conclusions Cognitive fatigue caused by additional cognitive demands during aerobic exercise may cancel beneficial postexercise effects on working memory. Cognitively demanding acute aerobic exercise appears to be less effective than simple aerobic exercise in improving executive function.

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Looking Further When Symptoms Are Disproportionate to Physical Findings

A 36-yr-old man presents with left ulnar-side wrist pain during an ice hockey game that prevented him from playing hockey or golf. There was no acute mechanism of injury. The usual clinical examination revealed only minimal tenderness and minimal pain with resisted wrist extension. Careful attention to precipitating factors led to testing resisted wrist extension with the forearm fully supinated, which reliably reproduced the intensity of the patient's symptoms, and a diagnosis of extensor carpi ulnaris tendinopathy. A literature review suggested three additional special tests (two were positive) and management. However, a standard of care has yet been established because neither the tests nor the management has been properly validated through research, thus leaving the management of this condition as an art.

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The Health Risks of Obesity Have Been Exaggerated

No abstract available

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ESR1 rs2234693 Polymorphism Is Associated with Muscle Injury and Muscle Stiffness

Purpose Muscle injury is the most common sports injury. Muscle stiffness, a risk factor for muscle injury, is lower in females than in males, implying that sex-related genetic polymorphisms influence muscle injury associated with muscle stiffness. The present study aimed to clarify the associations between two genetic polymorphisms (rs2234693 and rs9340799) in the estrogen receptor 1 gene (ESR1) and muscle injury or muscle stiffness. Methods In study 1, a questionnaire was used to assess the muscle injury history of 1311 Japanese top-level athletes. In study 2, stiffness of the hamstring muscles was assessed using ultrasound shear wave elastography in 261 physically active young adults. In both studies, rs2234693 C/T and rs9340799 G/A polymorphisms in the ESR1 were analyzed using the TaqMan SNP Genotyping Assay. Results In study 1, genotype frequencies for ESR1 rs2234693 C/T were significantly different between the injured and noninjured groups in a C-allele dominant (CC + CT vs TT: odds ratio, 0.62; 95% confidence interval, 0.43–0.91) and additive (CC vs CT vs TT: odds ratio, 0.70; 95% confidence interval, 0.53–0.91) model in all athletes. In study 2, hamstring muscle stiffness was lower in subjects with the CC + CT genotype than in those with the TT genotype; a significant linear trend (CC

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Supraspinal Fatigue and Neural-evoked Responses in Lowlanders and Sherpa at 5050 m

Purpose At high altitude, Lowlanders exhibit exacerbated fatigue and impaired performance. Conversely, Sherpa (native Highlanders) are known for their outstanding performance at altitude. Presently, there are no reports comparing neuromuscular fatigue and its etiology between Lowlanders and Sherpa at altitude. Methods At 5050 m, nine age-matched Lowlanders and Sherpa (31 ± 10 vs 30 ± 12 yr, respectively) completed a 4-min sustained isometric elbow flexion at 25% maximal voluntary contraction (MVC) torque. Mid-minute, stimuli were applied to the motor cortex and brachial plexus to elicit a motor-evoked potential and maximal compound muscle action potential (Mmax), respectively. Supraspinal fatigue was assessed as the reduction in cortical voluntary activation (cVA) from prefatigue to postfatigue. Cerebral hemoglobin concentrations and tissue oxygenation index (TOI) were measured over the prefrontal cortex by near-infrared spectroscopy. Results Prefatigue, MVC torque, and cVA were significantly greater for Lowlanders than Sherpa (79.5 ± 3.6 vs 50.1 ± 11.3 N·m, and 95.4% ± 2.7% vs 88.2% ± 6.6%, respectively). With fatigue, MVC torque and cVA declined similarly for both groups (~24%–26% and ~5%–7%, respectively). During the task, motor-evoked potential area increased more and sooner for Lowlanders (1.5 min) than Sherpa (3.5 min). The Mmax area was lower than baseline throughout fatigue for Lowlanders but unchanged for Sherpa. TOI increased earlier for Lowlanders (2 min) than Sherpa (4 min). Total hemoglobin increased only for Lowlanders (2 min). Mmax was lower, whereas TOI and total hemoglobin were higher for Lowlanders than Sherpa during the second half of the protocol. Conclusions Although neither MVC torque loss nor development of supraspinal fatigue was different between groups, neural-evoked responses and cerebral oxygenation indices were less perturbed in Sherpa. This represents an advantage for maintenance of homeostasis, presumably due to bequeathed genotype and long-term altitude adaptations.

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How Sickle Cell Disease Impairs Skeletal Muscle Function: Implications in Daily Life

Sickle cell disease (SCD) is the most frequent life-threatening genetic hemoglobinopathy in the world and occurs due to the synthesis of abnormal hemoglobin S (HbS). hemoglobin S-containing red blood cells (RBC) are fragile, leading to hemolysis and anemia, and adhere to the endothelium, leading to hemorheological and hemodynamical disturbances. In its deoxygenated form, HbS may polymerize, leading to sickling of red blood cells and potentially to vasoocclusive crises. Recent findings observed that SCD patients demonstrate significant skeletal muscle remodeling and display reduced muscle functional capacities, contributing to exercise intolerance and poor quality of life. Although acute high-intensity exercise is not recommended for SCD patients because it may increase the risk of sickling, regular moderate-intensity physical activity could have beneficial effects on skeletal muscle and more generally on the well-being of SCD patients. This article reviews the literature regarding the impact of the disease on muscular tissue characteristics and function, as well as the corresponding implications for SCD patients' quality of life.

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O2 Pulse Patterns in Male Master Athletes with Normal and Abnormal Exercise Tests

Purpose The clinical relevance of abnormal exercise testing (ET) results (at least 0.1 mV ST segment depression measured during exercise or recovery in three consecutive beats) in athletes without obstructive coronary artery disease (CAD) is not well understood. It is unknown whether this phenomenon reflects a physiological adaptation to sport or a truly ischemic response and a concomitant attenuated stroke volume (SV) response. The aim of this study was to investigate if athletes with abnormal ET results without obstructive CAD showed signs of an attenuated SV response using cardiopulmonary ET parameters. Methods A total of 78 male master athletes with abnormal ET results without obstructive CAD underwent cardiopulmonary ET. ΔO2 pulse/Δwork rate (WR), ΔV˙O2/ΔWR, and Δheart rate (HR)/ΔWR were assessed and compared with data from 78 male master athletes with normal ET results, matched for age, sports characteristics, and exercise capacity. Results The ΔO2 pulse/ΔWR ratio beyond anaerobic threshold in athletes with abnormal ET results was lower than that in athletes with normal ET results (0.73 ± 0.41 vs 1.12 ± 0.54, respectively, P

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Repetitive Head Impacts in Football Do Not Impair Dynamic Postural Control

Purpose The purpose of this study was to assess the effect of repetitive head impacts experienced by football players compared to noncontact athletes on dynamic postural control during both single-task (ST) and dual-task (DT) conditions. Methods Thirty-four football players wearing accelerometer instrumented helmets and 13 cheerleaders performed a dynamic postural control battery, consisting of ST and DT gait initiation, gait, and gait termination, both prior to and following the football season. A 2 (group) × 2 (time) repeated measures ANOVA compared performance across 32 dynamic postural outcomes. A linear regression was performed on postural control change scores with common head impact kinematics serving as the independent variables. Results The football players experienced a mean of 538.1 ± 409.1 head impacts in the season with a mean linear acceleration of 27.8g ± 3.2g. There were no significant interactions for any of the ST or DT dynamic postural control tasks. There was a significant relationship between head impact kinematics and the lateral center of pressure displacement during the anticipatory postural adjustment phase (r2 = 0.26, P = 0.010) and transitional phase (r2 = 0.511, P = 0.042) during ST gait initiation. For both measures, the number of impacts exceeding 98g was the only significant predictor of decreased center of pressure displacement. Conclusions A single competitive football season did not adversely affect dynamic postural control when comparing football players to cheerleaders who do not experience repetitive head impacts. Furthermore, there were limited relationships with head impact kinematics suggesting that a single season of football does not adversely affect most outcome measures of instrumented dynamic postural control. These findings are consistent with most studies which fail to identify clinical differences related to repetitive head impacts.

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Brain-derived Neurotrophic Factor Pathway after Downhill and Uphill Training in Rats

Introduction The elevation of brain-derived neurotrophic factor (BDNF) levels in the brain and the subsequent phosphorylation of its cognate tropomyosin-related kinase B (TrkB) receptors at tyrosine 816 (pTrkBtyr816) are largely involved in the positive effect of aerobic exercise on brain functioning. Although BDNF levels were reported to increase in proportion with exercise intensity, the effect of the type of contraction is unknown. Therefore, the cerebral BDNF/TrkB pathway was investigated after uphill and downhill treadmill activities at equivalent intensity to preferentially induce eccentric and concentric contractions, respectively. Methods A treadmill activity (30 min·d−1 for seven consecutive days) either in a horizontal position at two different speeds to modulate intensity (experiment 1) or at three different inclinations (null, −10%, and +5%) but at equivalent intensity to modulate the type of contraction (experiment 2) was induced in rats. Both experiments included sedentary rats. Levels of BDNF, pTrkBtyr816, synaptophysin (marker of synaptogenesis), endothelial nitric oxide synthase phosphorylated at serine 1177 (peNOSser1177), and c-fos levels (indicators of elevation in blood flow in the cerebrovasculature and neuronal activity, respectively) were measured in motor- and cognition-related brain regions using Western blotting analysis. Results Experiment 1 indicated that treadmill activity induces an intensity-dependent increase in peNOSser1177, c-fos, and BDNF levels. Experiment 2 showed that intensity of exercise as well as activation of the cerebral BDNF pathway, and synaptogenesis did not differ among horizontal, uphill, and downhill treadmill activities. Conclusion The cerebral response of the BDNF pathway to a treadmill activity is dependent on exercise intensity, but not on the type of contraction (eccentric vs concentric).

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Preexercise Carbohydrate Ingestion and Transient Hypoglycemia: Fasting versus Feeding

Purpose Carbohydrate (CHO) ingestion 30 to 45 min before exercise results in transient hypoglycemia after starting the exercise in some, but not all, subjects. However, whether transient hypoglycemia is more likely to occur under fed or fasted condition remains unknown. This study aimed to directly compare the effects of fasting versus feeding on plasma glucose responses after preexercise CHO intake and to examine the relationship between insulin responses and onset of transient hypoglycemia. Methods Sixteen subjects performed 60-min cycle ergometer exercises at 75% maximal oxygen uptake (V˙O2max) under overnight fasted and fed (4 h after breakfast) conditions. In both conditions, they consumed 500 mL of beverage (150 g of glucose) 30 min before beginning exercise. Results The mean plasma glucose concentrations 15 min after starting the exercise did not fall below 4.0 mmol·L−1 (criteria for hypoglycemia) in both states; however, individual differences in the occurrence of transient hypoglycemia were noted. In the fasted state, plasma glucose levels transiently dropped below 4.0 mmol·L−1 in five subjects, who had substantially higher serum insulin levels at the start of exercise, compared with those who did not develop hypoglycemia. Although seven subjects developed transient hypoglycemia in the fed state, no relationship was observed between insulin responses and hypoglycemia. Three subjects developed hypoglycemia in both fasted and fed states. Conclusions These results suggest that transient hypoglycemia after preexercise CHO ingestion occurs in some, but not all, subjects, under both conditions. Furthermore, subjects with enhanced insulin responses seem to be more prone to transient hypoglycemia in the fasted condition.

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Physical Activity Patterns and Mortality: The Weekend Warrior and Activity Bouts

Purpose This study aimed to examine how accelerometer-assessed physical activity accumulation patterns (e.g., is activity performed daily or only 1 or 2 d·wk−1 or is activity accrued in bouts) may affect the association with mortality. Methods Adults (N = 3438), age 40 yr and older, who wore an accelerometer (ActiGraph 7164), were drawn from the longitudinal follow-up of the National Health and Nutritional Examination Survey (2003–2006), a population-based survey of the United States. Accelerometer-assessed moderate-to-vigorous physical activity (MVPA) was described by activity patterns. Participants engaging in the majority of their activity on only 1 or 2 d·wk−1· were classified as "weekend warriors." Activity bouts were defined as a period of at least moderate intensity lasting at least 10 min. Bout characteristics included bout frequency and length. Mortality was assessed through National Death Index matching through 2013. Mortality rates were compared among groups with different activity patterns. Results Over an average follow-up of 77.4 months, 394 deaths occurred. Compared to participants with

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Mediating Effect of Muscle on the Relationship of Physical Activity and Bone

Purpose This study analyzed prospective associations between distinct trajectories of objectively measured physical activity (PA) and late adolescent bone parameters and explored the mediating effects of lean soft tissue, a surrogate of muscle mass to associations. Methods Physical activity was measured by accelerometry starting at age 5 yr and continuing at 8, 11, 13, 15, and 17 yr in approximately 524 participants from the Iowa Bone Development Study. Sex-specific group-based trajectory modeling was used to construct developmental trajectories of moderate- and vigorous-intensity PA (MVPA) from childhood to late adolescence. At age 17 yr, proximal femur bone mineral density (aBMD) was assessed by dual X-ray energy absorptiometry, and its distribution was calculated by aBMD ratios. Specific geometric measures of the proximal femur were assessed using hip structural analysis. Results A significant portion of the total effect of MVPA from age 5 to 17 yr on bone parameters at age 17 yr was explained by an increase in leg lean soft tissue in both sexes. For males and females, indirect effects were observed on the total and all regional proximal femur aBMD, and on the ratio between the inferomedial and superolateral neck aBMD. The effect on the ratio between the trochanter and the total proximal femur was specific to females, whereas the effect on the hip axis length was specific to males. Direct effects of MVPA on aBMD were identified only in males. Conclusions Using robust mediation analysis, this is the first study addressing the indirect effect (through muscle) of PA across childhood and adolescence on proximal femur bone parameters. To improve bone health at the proximal femur, the results suggest PA interventions during growth that increase muscle mass, particularly in females.

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Demographic-specific Validity of the Cancer Prevention Study-3 Sedentary Time Survey

Purpose This study examined the 1-yr test–retest reliability and criterion validity of sedentary time survey items in a subset of participants from a large, nationwide prospective cohort. Methods Participants included 423 women and 290 men age 31 to 72 yr in the Cancer Prevention Study-3. Reliability was assessed by computing Spearman correlation coefficients between responses from prestudy and poststudy surveys. Validity was assessed by comparing survey-estimated sedentary time with a latent variable representing true sedentary time estimated from the 7-d diaries, accelerometry, and surveys through the method of triads. Sensitivity analyses were restricted to 566 participants with an average of 14+ h of diary and accelerometer data per day for 7 d per quarter. Results Reliability estimates for total sitting time were moderate or strong across all demographic strata (Spearman ρ ≥ 0.6), with significant differences by race (P = 0.01). Reliability estimates were strongest for the TV-related sedentary time item (Spearman ρ, 0.74; 95% confidence interval, 0.70–0.77). The overall validity coefficient (VC) for survey-assessed total sedentary time was 0.62 (95% confidence interval, 0.55–0.69), although VC varied by age group and activity level (P

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Predictors of Dropout in Exercise Trials in Older Adults: The Generation 100 Study

Purpose Dropout from exercise programs, both in the real world and in research, is a challenge, and more information on dropout predictors is needed for establishing strategies to increase the likelihood of maintaining participants in a prescribed exercise program. The aim of the present study was to determine the dropout rate and its predictors during a 3-yr exercise program in older adults. Methods In total, 1514 men and women (mean ± SD age = 72.4 ± 1.9 yr) were included in the present study. Participants were randomized to either a supervised exercise intervention or to follow national guidelines for physical activity (PA). Self-reported demographics (e.g., education), general health, morbidity (e.g., heart disease, memory loss, and psychological distress), smoking, and PA were examined at baseline. Cardiorespiratory fitness (CRF) and grip strength were directly measured at baseline. Dropout rate was evaluated after 1 and 3 yr. Multivariate logistic regression analysis was used to identify dropout predictors. Results The total dropout rate was 11.0% (n = 166) after 1 yr and 14.9% (n = 225) after 3 yr. Significant predictors of dropout after 1 yr were low education, low grip strength, lower cardiorespiratory fitness, low PA level, and randomization to supervised exercise. The same predictors of dropout were significant after 3 yr, with reduced memory status as an additional predictor. Conclusion This is the largest study to identify dropout predictors in a long-term exercise program in older adults. Our findings provide new and important knowledge about potential risk factors of dropout in long-term exercise programs in older adults.

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Differences in Hip and Knee Landing Moments across Female Pubertal Development

Purpose The higher prevalence of knee injuries among adolescent females may be related to female pubertal development. The aim of this study was to determine whether girls exhibit higher triplanar knee and hip moments with more advanced pubertal development during a single-limb landing. Methods Lower-limb biomechanics of 93 females grouped according to prepubertal (n = 31), early/midpubertal (n = 31) and late/postpubertal (n = 31) development performed a single-limb drop lateral jump. Peak triplanar knee moments and hip moments at the time of peak knee moments were derived from a Vicon motion analysis system and concealed force plate. Joint moments were normalized to body mass (N·m·kg−1), height (N·m·kg−1·m−1) and body mass by height (N·m·kg−1·m−1). Between-group differences were analyzed using a one-way ANOVA with Pearson correlations used to explore relationships between joint moments and anthropometrics. Results Girls at latter stages of puberty landed with higher triplanar knee moments and hip flexion moment at time of peak knee flexion moment when normalized separately to body mass and to height (P

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Leucine Metabolites Do Not Enhance Training-induced Performance or Muscle Thickness

Leucine metabolites, α-hydroxyisocaproic acid (α-HICA) and β-hydroxy-β-methylbutyrate (calcium, HMB-Ca and free acid, HMB-FA), have been proposed to augment resistance training-induced changes in body composition and performance. Purpose We aimed to conduct a double-blind randomized controlled pragmatic trial to evaluate the effects of off-the-shelf leucine metabolite supplements of α-HICA, HMB-FA, and HMB-Ca on resistance training-induced changes in muscle thickness and performance. Methods Forty men were randomly assigned to receive α-HICA (n = 10, fat-free mass [FFM] = 62.0 ± 7.1 kg), HMB-FA (n = 11, FFM = 62.7 ± 10.5 kg), HMB-Ca (n = 9, FFM = 65.6 ± 10.1 kg), or placebo (PLA; n = 10, FFM = 64.2 ± 5.7 kg). The training program consisted of whole body thrice weekly resistance training for 8 wk (seven exercises per session, three to four sets per session, at 70%–80% one repetition maximum). Skeletal muscle thickness by ultrasound, performance measures, and blood measures (creatine kinase, insulin-like growth factor 1, growth hormone, cortisol, and total testosterone) were evaluated at baseline and at the end of weeks 4 and 8. Results Time-dependent changes were observed for muscle thickness (P

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Thermal Behavior Differs between Males and Females during Exercise and Recovery

Introduction This study tested the hypothesis that females rely on thermal behavior to a greater extent during and after exercise, relative to males. Methods In a 24°C ± 1°C; (45% ± 10% RH) environment, 10 males (M) and 10 females (F) (22 ± 2 yr) cycled for 60 min (metabolic heat production: M, 117 ± 18 W·m−2; F, 129 ± 21 W·m−2), followed by 60-min recovery. Mean skin and core temperatures, skin blood flow and local sweat rates were measured continually. Subjects controlled the temperature of their dorsal neck to perceived thermal comfort using a custom-made device. Neck device temperature provided an index of thermal behavior and mean body temperature provided an index of the stimulus for thermal behavior. Data were analyzed for total area under the curve for exercise and recovery time points. To further isolate the effect of exercise on thermal behavior during recovery, data were also analyzed the minute mean body temperature returned to preexercise levels within a subject. Results There were no sex differences in metabolic heat production (P = 0.71) or body temperatures (P ≥ 0.10) during exercise. Area under the curve for neck device temperature during exercise was greater for F (−98.4°C·min−1 ± 33.6°C·min−1 vs −64.5°C·min−1 ± 47.8°C·min−1, P = 0.04), but did not differ during recovery (F, 86.8°C·min−1 ± 37.8°C·min−1; M, 65.6°C·min−1 ± 35.9°C·min−1; P = 0.11). In M, mean skin (P = 0.90), core (P = 0.70) and neck device (P = 0.99) temperatures had recovered by the time that mean body temperature had returned to preexercise levels. However, in F, neck device temperature (P = 0.04) was reduced while core temperature remained elevated (P

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Equivalent Hypertrophy and Strength Gains in β-Hydroxy-β-Methylbutyrate- or Leucine-supplemented Men

Ingestion of proteins with high leucine content during resistance training (RT) can augment hypertrophy. Some data suggest that a leucine metabolite, β-hydroxy, β-methylbutyrate (HMB), is substantially more anabolically efficacious than leucine. Purpose We aimed to test whether supplementation with HMB versus leucine, added to whey protein, would result in differential muscle hypertrophy and strength gains in young men performing RT. Methods Twenty-six resistance-trained men (23 ± 2 yr) performed 12 wk of RT with three phases. Phase 1: 8 wk of periodized RT (three training sessions per week). Phase 2: 2 wk overreaching period (five sessions per week). Phase 3: 2 wk taper (three sessions per week). Participants were randomly assigned to twice daily ingestion of: whey protein (25 g) plus HMB (1.5 g) (whey+HMB; n = 13) or whey protein (25 g) plus leucine (1.5 g) (whey+leu; n = 13). Skeletal muscle biopsies were performed before and after RT. Measures of fat- and bone-free mass, vastus lateralis (VL) muscle thickness and muscle cross-sectional area (CSA) (both by ultrasound), muscle fiber CSA, and 1-repetition maximum (1-RM) strength tests were determined. Results We observed increases in fat- and bone-free mass, VL muscle thickness, muscle CSA and fiber type CSA and 1-RM strength with no differences between groups at any phase. We observed no differences between groups or time–group interactions in hormone concentrations at any phase of the RT program. Conclusions β-Hydroxy-β-methylbutyrate added to whey did not result in greater increases in any measure of muscle mass, strength, or hormonal concentration compared to leucine added to whey. Our results show that HMB is no more effective in stimulating RT-induced hypertrophy and strength gains than leucine.

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Does Exercise Alter Gut Microbial Composition? A Systematic Review

Purpose The objective of this systematic review of literature was to evaluate and summarize published research that has investigated the association between exercise and gut microbial composition in mammals. Methods This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases searched for this review included: PubMed; PubMed Central; Medline; Cumulative Index of Nursing and Allied Health Literature; Web of Science; Commonwealth Agricultural Bureaux Direct; Health Source: Nursing Academic Edition; Clinicaltrials.gov; International Prospective Register of Systematic Reviews (PROSPERO); and the Cochrane Library. Results Twenty-five articles met the inclusion criteria: 17 rodent, one canine, two equine, and five human studies. All studies in rodents and equines included control groups; whereas only one study in humans included a control group. The remaining were cross-sectional or cohort studies. All studies in rodents controlled for dietary intake and one study in humans implemented a 3-d dietary control. Eleven studies assessed voluntary exercise and 13 studies used forced exercise. Diversification within the Firmicutes phylum was consistently observed in exercise groups across studies. There were no consistent trends within Bacteroidetes, Actinobacteria, or Proteobacteria phyla. In general, the potential interactions between exercise and diet composition and their respective influences on the intestinal microbiome were not well characterized. Conclusions Exercise was associated with changes in gut microbial composition, an increase in butyrate producing bacteria and an increase in fecal butyrate concentrations independent of diet in rodents and humans. The overall quality of evidence in the studies in humans was low and the risk of bias was unclear. Future studies with standardized reporting and rigorous dietary control in larger samples are needed to further determine the influence of exercise on gut microbial composition.

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High Antimicrobial Efficacy, Antioxidant Activity, and a Novel Approach to Phytochemical Analysis of Bioactive Polyphenols in Extracts from Leaves of Pyrus communis and Pyrus pyrifolia Collected During One Vegetative Season

Microbial Drug Resistance, Ahead of Print.


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Why orthotic devices could be of help in the management of Movement Disorders in the young

Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patient...

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Family surprises dispatcher who saved dad’s life

Two years after Stephanie Cifuentes helped save a man by giving CPR instructions, the family surprised her by coming to say "thank you"

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Predicting the appropriate size of the uncuffed nasotracheal tube for pediatric patients: a retrospective study.

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Predicting the appropriate size of the uncuffed nasotracheal tube for pediatric patients: a retrospective study.

Clin Oral Investig. 2018 Dec 12;:

Authors: Tsukamoto M, Yamanaka H, Yokoyama T

Abstract
OBJECTIVES: The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively.
MATERIALS AND METHODS: The 1-12-year patients underwent dental procedures under general anesthesia intubated nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed tube sizes were calculated. In addition, we compared the relationships between the predicted tube size and actually the intubated tube size.
RESULTS: The tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for tube size. The correspondence rates for the tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size tube were intubated actually; 56% and 70%. When the predicted tube size was 4.0-mm ID, 0.5 mm larger size tube was intubated actually; 66%.
CONCLUSIONS: The formula by height could be most suitable for the selection of size for pediatric nasotracheal intubation. When the predicted tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial.
CLINICAL RELEVANCE: The present data indicate that the selection of nasotracheal tube using the formula by height might be useful.

PMID: 30543025 [PubMed - as supplied by publisher]

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Family counseling: Keeping bonds strong

First responder families face unique stressors, which can be overcome with the help of a professional family counselor

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Heller myotomy is the optimal index procedure for esophageal achalasia in adolescents and young adults

Abstract

Background

There is limited and conflicting data on the optimal intervention for the treatment of achalasia in adolescents and young adults (AYA), Heller myotomy (HM), esophageal dilation (ED) or botulinum toxin injection (botox). The goal of this study is to determine the most appropriate index intervention for achalasia in the AYA population.

Methods

We completed a longitudinal, population-based analysis of the California (2005–2010) and New York (1999–2014) statewide databases. We included patients 9–25 years old with achalasia who underwent HM, ED or botox. Comparisons were made based on the patients' index procedure. Rates of 30-day complications, long-term complications, and re-intervention up to 14 years were calculated. Cox regression was performed to determine the risk of re-intervention, adjusting for patient demographics.

Results

A total of 442 AYAs were analyzed, representing the largest cohort of young patients with this disease studied to date. Median follow-up was 5.2 years (IQR 1.8–8.0). The overall rate of re-intervention was 29.3%. Rates of re-intervention for ED and botox were equivalent and higher than HM (65.0% for ED, 47.4% for botox and 16.4% for HM, p < 0.001). Ultimately, 46.9% of ED and botox patients underwent HM. The overall short-term complication rate was 4.3% and long-term, 1.9%. There was no difference in the short-term and long-term complication rates between intervention groups (p > 0.05). On adjusted analysis, ED and botox were associated with increased risks of re-intervention when compared to HM (HR 5.9, HR 4.8, respectively, p < 0.01). Black patients were found to have a risk of re-intervention twice that of white patients (HR 2.0, p = 0.05).

Conclusions

HM has a similar risk of complications but a significantly lower risk of re-intervention when compared to ED and botox. Based on our findings, we recommend HM as the optimal index procedure for AYAs with achalasia.

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The flipped classroom: Capnography in use

The flipped classroom is an inquiry-based learning strategy designed to improve student engagement, discovery and outcomes

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hand-foot syndrome due to paclitaxel: A rare case report p. 284 Pritam S Kataria, Pradip P Kendre, Apurva A Patel, Nahush Tahiliani, Vijay Bhargav, Honey Parekh DOI:10.4103/ijp.IJP_547_17 Hand-foot syndrome (HFS) is a relatively frequent adverse reaction to certain anticancer drugs. HFS is a type of dermatitis which has been most commonly described with 5-fluorouracil and capecitabine. However, HFS with paclitaxel is rare and has been reported sparingly in the literature. A 52-year-old male patient with recurrent carcinoma of the buccal mucosa was started on palliative chemotherapy regimen, injection paclitaxel (175 mg/m2) in combination with injection carboplatin. On post-chemotherapy day 13, the patient started developing pain, dysesthesia followed by bullae formation, and desquamation over palms and soles. Clinically, the patient had Grade 3 HFS characterized by symmetrical, tender skin lesions over the dorsal aspect of palms, and soles with desquamation necessitating interrupti

https://plus.google.com/u/0/+AlexandrosGSfakianakis/posts/b1LJWb9JV61

Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored Highly accessed article p. 73 Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18 There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.

Sunscreens

Sunscreens: Time to think beyond UV rays

p. 78

Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18   It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.

Idiopathic guttate hypomelanosis: An overview p. 83 Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18 Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this

Melasma p. 91 Rupali Dharni, Bhushan Madke, Adarsh L Singh, DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17 Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood’s lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood’s lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood’s lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.

PUVASOL and NBUVB in patients with vitiligo p. 96 Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17 Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achiev

Actinic keratosis in vitiligo after oral PUVAsol therapy with review p. 103 Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18 Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.

Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl p. 107 Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18 Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.

Erythema dyschromicum perstans in pregnancy p. 110 Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18 Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.

Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus p. 114 Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18 Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration “steroid-induced perilymphatic hypopigmentation and atrophy” has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.

Pigment International (Pigment Int) 2018 | July-December | Volume 5 | Issue 2

EDITORIAL
	Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored	p. 73
	Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18   There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
REVIEW ARTICLES
	Sunscreens: Time to think beyond UV rays	p. 78
	Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18   It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Idiopathic guttate hypomelanosis: An overview	p. 83
	Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18   Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES
	Correlation of clinicodermatoscopic and Wood's lamp findings in patients having melasma	p. 91
	Rupali Dharni, Bhushan Madke, Adarsh L Singh,  DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17   Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood's lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood's lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood's lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	A study of comparison of PUVASOL and NBUVB in patients with vitiligo	p. 96
	Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17   Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achieved, twice a week on non-consecutive days. Group B patients received PUVASOL-oral Trimethylpsoralen or topical 0.2% w/w Trioxsalen followed by exposure to sunlight, twice a week on non-consecutive days. The extent of repigmentation was documented at regular intervals upto 6 months. Results: Amongst patients receiving NBUVB and PUVASOL, 56% and 48% had ≥50% repigmentation respectively. Disease was unstable in 48% and 36% of patients prior to commencement of therapy which reduced to 12% and 16% after therapy, respectively. 16% and 36% of the patients experienced side effects and 76% and 48% showed excellent colour match of the repigmented patches respectively. Conclusion: While both PUVASOL and NBUVB are both good therapeutic options; NBUVB therapy is found to be more effective and more cosmetically acceptable, with better colour matching of lesions and minimal adverse effects.
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CASE REPORTS
	Actinic keratosis in vitiligo after oral PUVAsol therapy with review	p. 103
	Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18   Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl	p. 107
	Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18   Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Erythema dyschromicum perstans in pregnancy	p. 110
	Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18   Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus	p. 114
	Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18   Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration "steroid-induced perilymphatic hypopigmentation and atrophy" has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
LETTER TO EDITOR
	Dermoscopy − Master by analysis and patience, not haste and nonchalance	p. 117
	Sidharth Sonthalia, Abhijeet K Jha, Manal Bosseila, Enzo Errichetti DOI:10.4103/Pigmentinternational.Pigmentinternational_38_17
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THE CLINICAL PICTURE
	Bilateral nevus of Ota	p. 120
	M. M. Aarif Syed, Bibush Amatya, Shazia Alam DOI:10.4103/Pigmentinternational.Pigmentinternational_1_18
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THROUGH THE DERMOSCOPE
	Dermoscopy of pigmented basal cell carcinoma	p. 123
	Kinjal D Rambhia, Vrutika H Shah, Rajesh P Singh DOI:10.4103/Pigmentinternational.Pigmentinternational_13_18
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CURRENT BEST EVIDENCE
	Current Best Evidence in Pigmentary Dermatology	p. 125
	Divya Kamat, Vinay Keshavamurthy DOI:10.4103/Pigmentinternational.Pigmentinternational_22_18
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CROSSWORD
	PIGMENTCROSS 4	p. 130
	Ashish Amrani, Anupam Das DOI:10.4103/Pigmentinternational.Pigmentinternational_24_18
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