Vibhavadi Hospital

Hair transplantation using the sharp implanter method is increasing in popularity. However, there has been little discussion pertaining to surgical know-how or specific techniques that increase efficiency and precision. We describe surgical techniques that enable dense packing in a swift and efficient fashion with the sharp implanter method using photos and videos. Grafts were placed using the sharp implanter method while adhering to several important principles. Eleven principles regarding the following aspects of hair transplant surgery were explained: gripping the implanter, graft placing technique that minimizes graft popping and tissue trauma when using the implanter, efficient team surgery system with assistant staff, direction and sequence of graft insertion, effective regimen for using epinephrine to control bleeding, selection of appropriately sized implanter tip, selection and usage of wide and narrow channel implanter tips, importance and methods of depth control, and staff training. High graft survival and dense and natural hair density can be obtained with the sharp implanter method when performed in compliance with the principles described here. Appropriate use of the sharp implanter technique allows efficient and rapid graft insertion and achieves natural outcomes.

Strongyloidiasis is a disease caused by Strongyloides stercoralis and remains a neglected tropical infection despite significant public health concerns. Challenges in the management of strongyloidiasis arise from wide ranging clinical presentations, lack of practical high sensitivity diagnostic tests, and a fatal outcome in immunocompromised hosts. Migration, globalization, and increased administration of immunomodulators, particularly during the COVID-19 era, have amplified the global impact of strongyloidiasis. Here, we comprehensively review the diagnostic tests, clinical manifestations, and treatment of strongyloidiasis. The review additionally focuses on complicated strongyloidiasis in immunocompromised patients and critical screening strategies. Diagnosis of strongyloidiasis is challenging because of non-specific presentations and low parasite load. In contrast, treatment is simple: administration of single dosage ivermectin or moxidectin, a recent anthelmintic drug. Undiagnosed infections result in hyperinfection syndrome and disseminated disease when patients become immunocompromised. Thus, disease manifestation awareness among clinicians is crucial. Furthermore, active surveillance and advanced diagnostic tests are essential for fundamental management.

Scalp micropigmentation has developed rapidly in recent years to the extent that it is now considered a major means of hair loss treatment along with medication and hair transplantation. To deliver correct information in terms of patients' curiosity regarding scalp micropigmentation and the most frequent complaints that doctors receive as well as to rectify misinformation. A review of the literature was performed, and information is herein presented on various scalp micropigmentation procedures, the authors' experiences in this area, and special tips to achieve a natural result. The fundamental knowledge and proper techniques described in this article can aid in achieving more successful scalp micropigmentation results. Scalp micropigmentation is a widely used technique to camouflage various scalp scars and alopecia; therefore, it is important to be aware of the principles and skills necessary to achieve a natural result.

Alterations in the expanded endocannabinoid system (eECS) and cell membrane composition have been implicated in the pathophysiology of schizophrenia spectrum disorders. We enrolled 54 antipsychotic (AP)-naïve first-episode psychosis (FEP) patients and 58 controls and applied a targeted metabolomics approach followed by multivariate data analysis to investigate the profile changes in the serum levels of endocannabinoids: 2-arachidonoylglycerol (2-AG) and anandamide, endocannabinoids-like N-acylethanolamines (NAEs: linoleoylethanolamide, oleoylethanolamide, and palmitoylethanolamide), and their dominating lipid precursor’s phosphatidylcholines. Biomolecule profiles were measured at the onset of first-episode psychosis (FEP) and 0.6 years and 5.1 years after the initiation of AP treatment. The results indicated that FEP might be characterized by elevated concentrations of NAEs and by decreased 2-AG levels. At this stage of the disease, the NAE-mediated upregulation of peroxisome proliferator-activated receptors (PPARs) manifested themselves in energy expenditure. A 5-year disease progression and AP treatment adverse effects led to a robust increase in 2-AG levels, which contributed to strengthened cannabinoid (CB1) receptor-mediated effects, which manifested in obesity. Dynamic 2-AG, NAEs, and their precursors in terms of phosphatidylcholines are relevant to the description of the metabolic shifts resulting from the altered eECS function during and after FEP.

BackgroundConcentration and physical strength are essential for the long duration of hair transplant surgery. Because both the patient and the doctor must maintain certain postures for long periods, the importance of ergonomics cannot be understated.AimsTo review the devices, instruments, and techniques developed for ergonomic follicular unit excision surgery, to present our experience with various ergonomic modifications, and to evaluate the effectiveness of the related devices, novel concepts, and methods.MethodsWe evaluated the scientific evidence supporting the ideas, methods, devices, and systems to help create a better ergonomic environment, and we investigated how these elements can be fine‐tuned to improve efficiency when performing follicular unit excision graft harvesting.ResultsThrough innovative methods, ideas, devices, and instruments, the authors achieved a high‐quality ergonomic environment for performing follicular unit excision.ConclusionFollicular unit excision is a widely used technique in hair restoration surgery. However, follicular unit excision is a very laborious and time‐consuming procedure and mandates the best ergonomic conditions for both the surgeon and the patient. Therefore, it is crucial that the physician understands and appropriately adopts the various means and techniques to provide an ergonomic environment.

Abstract BackgroundThere has been a growing interest in the role of vitamin D for the well-being and physical performance of humans; however, there is a lack of long-term supplementation studies performed on members of the young, physically active, male population.The hypothesis of the study was that vitamin D supplementation during wintertime will decrease the prevalence of critically low vitamin D blood serum levels and increase hand grip strength during the winter season among young male conscripts. Study DesignLongitudinal, triple-blinded, randomized, placebo-controlled trial. MethodsFifty-three male conscripts from the Estonian Army were randomized into two groups: 27 to an intervention group and 26 to a placebo group. The groups were comparable in terms of their demographics. The intervention group received 1200 IU (30 µg) capsules of vitamin D3 and the control group received placebo oil capsules once per day. The length of the follow-up was seven months, from October 2016 until April 2017. Blood serum vitamin D (25(OH)D), parathyroid hormone (PTH), calcium (Ca), ionized calcium (Ca-i), testosterone and cortisol values and hand grip strength were measured four times during the study period. ResultsThe mean 25(OH)D level decreased significantly in the control group to a critically low level during the study, with the lowest mean value of 22 nmol/l found in March 2017. At that time point, 65% in the control group vs 15% in the intervention group had 25(OH)D values of less than 25 nmol/l (p < 0.001). In the intervention group the levels of 25(OH)D did not change significantly during the study period. All other blood tests revealed no significant differences at any time point. The corresponding result was found for hand grip strength at all time points. ConclusionLong-term vitamin D supplementation during wintertime results in fewer conscripts in the Estonian Army with critically low serum vitamin D (25(OH)D) levels during the winter season. However, this did not influence their physical performance in the form of the hand grip strength test. Trial registrationClinicalTrials.gov Identifier: NCT04359524. Registered 20 April 2020 - Retrospectively registered. https://register.clinicaltrials.gov

Background:Long hair follicular unit excision (LHF) allows surgeons to fully visualize hair curliness, which is crucial in eyebrow transplantation where matching curliness is a matter of utmost importance. In this study, we aimed to evaluate the clinical importance of LHF in eyebrow transplantation.Methods:A total of 36 patients who had undergone eyebrow transplantation surgery with LHF were enrolled. Twelve of the 36 patients had previously undergone unsatisfactory surgery at another clinic. Of these, 2 patients underwent complete laser eyebrow removal, and 3 patients underwent selective electro-cautery with unmatched hair curliness before surgery. The remaining 7 patients underwent surgery to increase eyebrow hair density or to reshape their eyebrows. A satisfaction survey was administered to patients > 6 months after the procedure.Results:All patients showed natural eyebrow transplant results at their follow-up visits and were satisfied with the results. Patient and surgeon satisfaction scores were 4.7 and 4.3, respectively. Four patients underwent a touch-up procedure to increase hair density with 21, 43, 12, and 45 follicular units, respectively, and were satisfied with the results. There were no cases of asymmetry or adverse events, such as folliculitis.Conclusions:The authors derived satisfactory results from the patients who underwent eyebrow transplantation by the LHF method. Therefore, we conclude that LHF is a suitable surgical method for eyebrow hair transplantation.

Nitrosamine impurities in angiotensin II receptor antagonists (sartans) containing a tetrazole group represent an urgent concern for active pharmaceutical ingredient (API) manufacturers and global regulators. Regarding safety, API manufacturers must develop methods to monitor the levels of each nitrosamine impurity before individual batch release. In this study, we developed and validated a sensitive, selective, and high-throughput method based on headspace gas chromatography–mass spectrometry (HS-GC–MS) for the simultaneous determination of four nitrosamines in losartan potassium API with simple sample preparation. N-Nitrosodimethylamine (NDMA, m/z 74), N-nitrosodiethylamine (NDEA, m/z 102), N-nitrosoethylisopropylamine (EIPNA, m/z 116), and N-nitrosodiisopropylamine (DIPNA, m/z 130) levels were quantified using an electron impact, single quadrupole mass spectrometer under a selected-ion-monitoring acquisition method. The method was validated according to the Q2(R1) ICH guidelines. The calibration curves of the assay ranged from 25 to 5000 ng/mL with limits of quantitation of 25 ppb for NDMA and NDEA and 50 ppb for DIPNA and EIPNA. The accuracy of the developed method ranged from −7.04% to 7.25%, and the precision %CV was ≤11.5. Other validation parameters, including specificity, stability, carryover, and robustness, met the validation criteria. In conclusion, the developed method was successfully applied for the determination of nitrosamines in losartan potassium APIs.