Ministry of External Affairs

INTRODUCTION: The impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma. METHODS: Using data from an online UK-wide survey of 4500 people with asthma (median age 50-59 years, 81% female), conducted in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting having had COVID-19. RESULTS: The COVID-19 group (n=471, 10.5%) reported increased inhaler use and worse asthma management, compared with those not reporting COVID-19, but did not differ by gender, ethnicity or household income. Among the COVID-19 group, 56.1% reported having long COVID, 20.2% were 'unsure'. Those with long COVID were more likely than those without long COVID to describe: their breathing as worse or much worse after their initial illness (73.7% vs 34.8%, p<0.001), increased inhaler use (67.8% vs 34.8%, p<0.001) and worse or much worse asthma management (59.6% vs 25.6%, p<0.001). Having long COVID was not associated with age, gender, ethnicity, UK nation or household income.Analysis of free text survey responses identified three key themes: (1) variable COVID-19 severity, duration and recovery; (2) symptom overlap and interaction between COVID-19 and asthma; (3) barriers to accessing healthcare. CONCLUSIONS: Persisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma.

‘No nation can escape its geography’, warned Percy Spender, Australia’s Minister for External Affairs, in 1950. With the immediate turmoil of World War II over, communism and decolonisation had ended any possibility that Asia could continue to be ignored by Australia. In the early 1950s, Australia embarked on its most ambitious attempt to engage with Asia: the Colombo Plan.

Few issues have acquired priority in the international agenda in as short a time as global warming. Up to the early 1970s many scientists believed that the Earth might be moving towards a new ice age and that increasing levels of emissions of greenhouse gases (GHGs) from human activities would not alter this course and might even be helpful in slowing down this movement. It was only towards the close of the decade that scientific opinion tentatively endorsed the view that on average global temperatures might be rising. The first World Climate Conference, organized by the World Meteorological Organization (WMO) in Geneva in 1979, cautiously concluded that:

The production of dormant eggs is a crucial adaptation for African killifish of the genus Nothobranchius to survive in temporary waters. These habitats are often characterized by unpredictable variation in the suitability of growing seasons as a result of variable lengths of inundations and temporary colonization by piscivorous fish. Incomplete hatching could enable killifish to buffer against reproductive failure during unsuitable inundations. Although this phenomenon has been tentatively linked to variation in dormancy states, it has never been investigated under controlled conditions and its viability as a bet hedging strategy to distribute offspring over several inundations remains unclear. In the present study, we used common garden experiments to assess the contribution of environmental modulation and bet hedging to delayed hatching in Nothobranchius killifish by testing the feasibility of arrested development in the presence and absence of environmental cues. Overall, the results confirmed that the presence of cues signalling a threat (predator kairomones) inhibited hatching. However, delayed development also occurred independent of cues and was regulated at two stages. Developmental arrest in energy-efficient dormancy stages could present a means for long-term bet hedging over years, whereas arrest in the energy-consuming final stage may serve a similar purpose over shorter time scales.

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute a consult. As one bioethicist commented: if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics.

"Sometimes you have to travel a long way to find what is near." This quote by Paulo Coelho stands true for platelet-rich plasma (PRP) as we know of it today. Large strides have been made to understand this "youth" in blood, but there still seems a long way to go in our understanding of it. Despite advances, clarity in its preparation, biology, and the properties of the final product still remains elusive. The concepts of an ideal number or concentration of platelets in the final enriched plasma, best devices to prepare PRP, an ideal hardware, standard parameters for its preparation, the need for its activation or buffering of the final preparation or whether anticoagulants should be used or not, have evolved, since it was first described. The authors present an analysis of PRP present day status and its usefulness in field of medicine with a review of published literature from "Medline" (via "PubMed"), "Cochrane," the Virtual Health Library, and Google Scholar related to PRP, its biology, types, and classifications, preparation, and use.

BACKGROUND: Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an esthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. AIMS: The objective of this article was to discuss etiology, pathophysiology, and treatment of cellulite. MATERIALS AND METHODS: Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analysis, and relevant information from selected websites were included. RESULTS: Several treatment options from lifestyle modifications and topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. DISCUSSION: Methodological differences in the trials conducted make it difficult to compare different treatment modalities. CONCLUSION: Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. A combination of treatments is often required in most patients for reducing cellulite.

OBJECTIVE: Evaluate the possibility of performing a complex vascular allotransplant of all neck organs including skin. SUMMARY BACKGROUND DATA: There are 2 previous attempts described in the literature, none of them being that complex. The first one is nonfunctional due to chronic rejection, the second one is viable yet considerably limited in complexity (no parathyroids, no skin). METHODS: The allotransplantation was performed simultaneously on 2 adjacent operating rooms, using microsurgical techniques. RESULTS: The patient's voice, breathing through mouth, swallowing, and endocrinal functions have been fully restored. CONCLUSIONS: Achieved results show clearly that such operations performed in selected patients can nearly fully restore functional and aesthetic effects in 1 single procedure.

Dermatologic TherapyVolume 33, Issue 4 e13359 Letter Solidarity and transparency against the COVID-19 pandemic Gulhima Arora, Gulhima Arora Department of Dermatology, Mehektagul Dermaclinic, New Delhi, IndiaSearch for more papers by this authorGeorge Kroumpouzos, George Kroumpouzos Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA Department of Dermatology, Medical School of Jundiaí, São Paulo, BrazilSearch for more papers by this authorMartin Kassir, Martin Kassir Worldwide Laser Institute, Dallas, Texas, USASearch for more papers by this authorMohammad Jafferany, Mohammad Jafferany orcid.org/0000-0001-6358-9068 College of Medicine, Central Michigan University, Saginaw, Michigan, USASearch for more papers by this authorTorello Lotti, Torello Lotti orcid.org/0000-0003-0840-1936 Department of Dermatology, University of Studies Guglielmo Marconi, Rome, ItalySearch for more papers by this authorRoxanna Sadoughifar, Roxanna Sadoughifar University of Rome G. Marconi, Rome, Italy Bidarskincenter, Tehran, IranSearch for more papers by this authorZuzanna Sitkowska, Zuzanna Sitkowska Department of Dermatology, Medical University of Warsaw, Warsaw, PolandSearch for more papers by this authorStephan Grabbe, Stephan Grabbe Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, GermanySearch for more papers by this authorMohamad Goldust, Corresponding Author Mohamad Goldust [email protected] orcid.org/0000-0002-9615-1246 University of Rome G. Marconi, Rome, Italy Department of Dermatology, University Medical Center Mainz, Mainz, Germany Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland Correspondence Mohamad Goldust, Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland. Email: [email protected]Search for more papers by this author Gulhima Arora, Gulhima Arora Department of Dermatology, Mehektagul Dermaclinic, New Delhi, IndiaSearch for more papers by this authorGeorge Kroumpouzos, George Kroumpouzos Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA Department of Dermatology, Medical School of Jundiaí, São Paulo, BrazilSearch for more papers by this authorMartin Kassir, Martin Kassir Worldwide Laser Institute, Dallas, Texas, USASearch for more papers by this authorMohammad Jafferany, Mohammad Jafferany orcid.org/0000-0001-6358-9068 College of Medicine, Central Michigan University, Saginaw, Michigan, USASearch for more papers by this authorTorello Lotti, Torello Lotti orcid.org/0000-0003-0840-1936 Department of Dermatology, University of Studies Guglielmo Marconi, Rome, ItalySearch for more papers by this authorRoxanna Sadoughifar, Roxanna Sadoughifar University of Rome G. Marconi, Rome, Italy Bidarskincenter, Tehran, IranSearch for more papers by this authorZuzanna Sitkowska, Zuzanna Sitkowska Department of Dermatology, Medical University of Warsaw, Warsaw, PolandSearch for more papers by this authorStephan Grabbe, Stephan Grabbe Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, GermanySearch for more papers by this authorMohamad Goldust, Corresponding Author Mohamad Goldust [email protected] orcid.org/0000-0002-9615-1246 University of Rome G. Marconi, Rome, Italy Department of Dermatology, University Medical Center Mainz, Mainz, Germany Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland Correspondence Mohamad Goldust, Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland. Email: [email protected]Search for more papers by this author First published: 31 March 2020 https://doi.org/10.1111/dth.13359Citations: 25Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume33, Issue4July/August 2020e13359 This article also appears in:Dermatologic Therapy COVID-19 Articles RelatedInformation

A risk assessment framework was developed to evaluate the zoonotic potential of avian influenza (AI), focusing on virus mutations linked to phenotypic traits related to mammalian adaptation identified in the literature. Virus sequences were screened for the presence of these mutations and their geographical, temporal and subtype-specific trends. Spillover events to mammals (including humans) and human seroprevalence studies were also reviewed. Thirty-four mutations associated with five phenotypic traits (increased receptor specificity, haemagglutinin stability, neuraminidase specificity, enhanced polymerase activity and evasion of innate immunity) were shortlisted. AI viruses (AIVs) carrying multiple adaptive mutations and traits belonged to both low and highly pathogenic subtypes, mainly to A(H9N2), A(H7N9), A(H5N6) and A(H3N8), were sporadic and primarily detected in Asia. In the EU/EEA, H5Nx viruses of clade 2.3.4.4b, which have increased opportunities for evolution due to widespread circulation in birds and occasional cases/outbreaks in mammals, have acquired the highest number of zoonotic traits. Adaptive traits, such as enhanced polymerase activity and immune evasion, were frequently acquired, while receptor-specific mutations remained rare. Globally, human cases remain rare, with the majority overall due to A(H5N1), A(H5N6), A(H7N9) and A(H9N2) that are among the subtypes that tend to have a higher number of adaptive traits. The main drivers of mammalian adaptation include virus and host characteristics, and external factors increasing AIV exposure of mammals and humans to wild and domestic birds (e.g. human activities and ecological factors). Comprehensive surveillance of AIVs targeting adaptive mutations with whole genome sequencing in animals and humans is essential for early detection of zoonotic AIVs and efficient implementation of control measures. All preparedness, preventive and control measures must be implemented under a One Health framework and tailored to the setting and the epidemiological situation; in particular, enhanced monitoring, biosecurity, genomic surveillance and global collaboration are critical for mitigating the zoonotic risks of AIV.

BACKGROUND: The external ear plays a significant aesthetic role in the appearance of the face. Chronological and extrinsic aging effects on the ear lobe get further pronounced since routine surgical aesthetic procedures for the face do not address these morphological changes. Ear adornment with jewelry and piercings further cause sagging of the ear lobe and stretch the ear piercing. Dermal fillers offer a viable option for ear lobe rejuvenation by increasing its volume and addressing the morphological changes with minimal adverse effects or downtime associated with surgery. AIMS: The authors aim to review the choice of dermal fillers used for ear lobule correction. The anatomy and its implications on techniques used for ear lobe rejuvenation are elaborated in this article based on the authors experience and reported literature. METHODS: All patients who had received ear lobe fillers were evaluated, treated and followed up. Literature review of experience of treating patients with hyaluronic acid fillers for ear lobule correction and their rejuvenation was reviewed. RESULTS: Hyaluronic acid fillers are a quick and easy method to restore the youthfulness and aesthetic ideals of the ear lobe. They address all the parameters of aging, volume deficit, reduction in the number and depth of creases and improvement in the number of wrinkles which surgical correction may not address. They can also be used for prejuvenation in younger populations expected to wear heavier ear jewelry. The results are immediate, long-lasting and the side effects and downtime are minimal.

Strict infection control measures in response to the current COVID-19 pandemic are expected to remain for an extended period. In aesthetic clinics, most procedures are provided on one to one basis by the physician or therapist. In such a scenario, guidelines detailing the infection control measures for aesthetic clinics are of particular importance. An online meeting of an international group of experts in the field of aesthetic medicine, with experience in administration of an aesthetic clinic, was convened. The meeting aimed to provide a set of consensus guidelines to protect clinic staff and patients from SARS-CoV-2 infection. Consensus guidelines for "preferred practices" were provided for scheduling of patients, patient evaluation and triaging, and for safety precautions about the different procedures. Procedures were categorized into low-risk, moderate risk, and high-risk based on the likelihood of transmission of SARS-CoV-2 virus from the patient to the treating physician or therapist. While not intended to be complete or exhaustive, these guidelines provide sound infection control measures for aesthetic practices. Since guidelines regarding safety measures and use of PPEs may vary from country to country, the local guidelines should also be followed to prevent COVID-19 infection in aesthetic clinics.

In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety.

INTRODUCTION: Severe asthma affects an estimated 3%-5% of people with asthma and is associated with frequent exacerbations, poor symptom control and significant morbidity from the disease itself, as well as high dose of inhaled and systemic steroids used to treat it. The introduction of specialist asthma services across the UK has attempted to improve quality of care and ensure that patients undergo a full systematic assessment prior to initiation of advanced biological therapies. However, improvements are required in the patient pathway to minimise avoidable harm. OBJECTIVES: To define standards of care in areas where the evidence base is lacking through patient and healthcare professional (HCP) consensus. METHODS: The precision UK National Working Group of asthma experts identified 42 statements formed from 7 key themes. An online four-point Likert scale questionnaire was sent to HCPs working in asthma throughout the UK to assess agreement (consensus) with these statements; a subset of the statements formed a patient questionnaire. Consensus was defined as high if ≥75% and very high if ≥90% of respondents agreed with a statement. RESULTS: A total of 117/197 responses (59.3% response rate) were received from severe asthma patients (n=15) and HCPs (n=102) including respiratory physicians, respiratory nurse specialists, respiratory pharmacists, specialist physiotherapists and general practitioners. Consensus was very high in 25 (60%) statements, high in 12 (29%) statements and was not achieved in 5 (12%) statements. Based on the consensus scores, the precision UK National Working Group derived 10 key recommendations. These focus on referrals from primary and secondary care, accessing specialist asthma services, homecare provision for severe asthma patients and outcome measures. CONCLUSIONS: Implementation of these 10 recommendations across the severe asthma pathway in the UK has the potential to improve outcomes for patients by reducing delays to assessment and initiation of advanced phenotype-specific therapies.

BACKGROUND: Comprehensive patient assessment and planning are central to esthetic treatment with injectables. MD ASA™ (Multi-Dimensional Aesthetic Scan Assessment) is a novel tool developed for this purpose. AIMS: To describe the MD ASA technique and present its preliminary application. METHODS: MD ASA breaks down the face into five hierarchies (H1-H5). H1 shifts patients' focus from "distractions" (individual lines and folds) toward the overall messages their face portrays, based on eight Emotional Attributes: four negative (tired, sad, angry, and saggy); four positive (youthful, attractive, contoured, and feminine/masculine). Three priority Emotional Attributes are selected for each patient. This is followed by a process of narrowing down through facial thirds (H2), periorbital and perioral dynamics (H3), facial units (H4), and subunits (H5), to arrive at a final assessment. Based on the key facial signs identified, this can be translated into MD Codes equations and thus a treatment formula. A retrospective analysis was performed based on 12 female patients injected by expert clinicians at an educational event. All patients were selected for, and treated using, a single MD Codes formula derived from a common MD ASA work-up. RESULTS: There were substantial differences between patients and clinicians in their views of which anatomical areas needed treatment-but good alignment on priority Emotional Attributes. Patients were treated only for three negative Emotional Attributes, but improvements were observed across all eight attributes. CONCLUSIONS: MD ASA provides a practical method for translating facial messages into actionable injectable treatment plans and facilitates greater patient-clinician alignment. Prospective studies are warranted.

Skin picking disorder (excoriation disorder) is a common psychodermatological disorder characterized by irresistible urges to pick skin on dominant hand accessible parts of the body. There is no specific recommended treatment available. Various pharmacological agents particularly selective serotonin reuptake inhibitors and glutamatergic agents have been tried with variable success. Habit reversal therapy has been commonly employed in the treatment and has some evidence-based success. This review focuses on the interdisciplinary team approach consisting of a liaison with psychiatry, in the management of this disorder. The specific roles of dermatologist and psychiatrist are discussed in detail.

The COVID-19 outbreak and rheumatologic skin diseases

Although our knowledge about the cutaneous manifestations of coronavirus disease (COVID-19) is evolving as the pandemic unfolds, there are many aspects of this global pandemic that we as dermatologists need to be well versed in.

RÉSUMÉCes dernières décennies, les villes africaines sont confrontées à des séries d’inondations en lien avec l’urbanisation rapide, l’intensification des fortes pluies et la défaillance du réseau de drainage pluvial. La prévision de ces inondations constitue un enjeu majeur, et passe par la cartographie précise et lisible des écoulements de surface. Cette étude, menée dans la périphérie urbaine de l’agglomération de Dakar, vise à proposer une méthode de calcul permettant de localiser les débordements du réseau de drainage à l’échelle de l’agglomération, avec des temps de calcul compatibles avec la prévision en temps réel. Après avoir décrit brièvement la méthode, l’article s’attache à montrer comment intégrer les différents objets urbains modifiant les directions de drainage ou les caractéristiques des écoulements (bâti, collecteurs, bassins de retenue) et restituer la topologie du drainage à une échelle fine (5 m). La méthode, basée sur un MNT, est décrite en présentant les algorithmes utilisés ou développés, illustrés par des exemples. Ces algorithmes sont opérationnels dans le logiciel ATHYS et son module Vicair. Cet article sera complété ultérieurement par la description de la modélisation hydrologique et hydraulique associée à cette topologie.

Continued rise in incidence and prevalence of diabetes globally warrants an effective strategy for its prevention and control. Prevention of diabetes seems more logical to attempt seeing its health care burden, long dormancy, systemic affliction and poor general awareness. Pre-diabetes is the intermediate state of erratic glucose metabolism without overt features of diabetes. This state seems to be a crossroad having a possibility to either convert into clinical diabetes, remain dormant or return to normal glucose control depending upon the efforts made. Unfortunately, due to the paucity of apparent clinical symptoms, this state embedded with reversal possibility, remains unexplored. Ayurveda account of prameha purvarupa (subclinical features of diabetes) may be proposed as the foundation upon which clinic-based pre-diabetes identification and subsequent prevention may be explored. Knowing the symptoms for their reliable proximity with upcoming diabetes may turn to be sensible sensitizers prompting the people to abort the disease process in an effective and timely manner. Considering diabetes from its purvarupa to complications as disease continuum and exploring the opportunities to intervene in order to prevent, or manage the disease on the basis of shada kriyaa kaala therefore, has a huge translational potential warrants an urgent exploration.