Asokan N | Kerala University Of Health Sciences (original) (raw)

Papers by Asokan N

Background and Objectives: There are conflicting opinions in previous studies whether the quality... more Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis
is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching
hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the
QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam
version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated
Spearman’s rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or
above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed
by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131,
P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03)
with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work,
and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.

Context: There is limited published data on psoriatic arthritis (PsA) from India. Aims: To analyz... more Context: There is limited published data on psoriatic arthritis (PsA) from India. Aims: To analyze the clinical and radiological findings of
patients with PsA attending a tertiary care teaching hospital. Settings and Design: Cross-sectional descriptive study in a dermatology
department of a tertiary care teaching hospital over a 1- year period. Materials and Methods: Demographic profile, clinical profile,
and radiological changes of patients with PsA were studied. Statistical Analysis Used: Qualitative data were analyzed using means,
percentages, and chi-square test and quantitative data were analyzed using Spearman’s rank correlation and Z-test. Results: There
were 53 patients (35 males). The most common age group was 40-59 years. The age of onset was earlier among females. The most
common type of PsA was asymmetric oligoarthritis (35/53; 66%). Overlapping types were seen in 19 (35.8%) patients. The knee was
the most common joint involved (21/53; 39.6%) followed by the distal interphalangeal (DIP) joint and shoulder joint (18/53 each; 34%).
Enthesitis and dactylitis were present in 3 (6%) and 7 (13.2%) patients, respectively. Nails were affected in 47 (88.7%) patients; the
most common finding was pitting of the nail plates. There was no correlation between clinical type of PsA and the severity of disease
as assessed by Psoriasis Area and Severity Index (PASI) and body surface area of involvement (BSA). Twenty-five (47.2%) patients
were either overweight or obese. A majority of the patients (41/53), particularly females (17/18), had central obesity. 34% of the patients
had systemic hypertension (HT), diabetes mellitus, or both. The most common (24.5%) radiological change was marginal erosion of
the phalanges. Conclusions: Asymmetric oligoarthritis was the most common clinical type of PsA. The knees, shoulders, and DIP
joints were the more commonly affected joints. Severity of psoriasis was not associated with any particular type of PsA. A majority of
patients, particularly females, had central obesity. The most common radiological finding was marginal erosion.

site supervision provided an opportunity to address performance issues with a quick feedback to t... more site supervision provided an opportunity to address performance issues with a quick feedback to the state headquarters. As reported by others, this helped ensure quality services, recording and reporting. There was two-to threefold improvement in four areas of performance; coverage, quality of clinic services, skill development of counsellors, and data collection. During the year 2009-2010, 23,317 patients were counselled as compared to 12,110 clients in the year 2008-2009 indicating a twofold increase in the level of utilization of counselling services in the second year. On the basis of the syndromic diagnosis, 12,469 patients were provided with prepackaged drug kits and treated. Partner notification was undertaken in 6042 index clients, and their 5891 partners (97.5%) were subsequently managed. Condoms were provided to 1,16,966 clients as against 20,118 in 2008-2009. Thirteen day intensive induction training was conducted for the STI counsellors as designed by NACO.The training proved to be very effective. The average training scores are depicted in . The difference of mean pre-and post-test scores were found to be statistically significant, P value = 0.01656 (<0.05). There was remarkable improvement in their knowledge as was evident from the significant difference between the pre-test and post-test scores ranging from 25.5 to 30.5 with an average gain index of 19.6. In the induction training session, the change in the attitude was from 0 to 0.8 based on the pre-and post-test scores. Attitudinal change was also noted by role plays. Intensive training was much appreciated by the STI counsellors, similar to the views expressed by ICTC counsellors. Supportive supervision is an excellent process-oriented, continuous, interactive methodology. It has an effective role in providing administrative and educative support but to sustain and have a long-term impact, it is essential to work closely with the supervisory STI team to develop a definite strategy. Besides, repeated refresher training is essential for upgradation of knowledge and skill development.

Ayoung lady was found to have hemihype rtrophy, scoliosis, subcutaneous swellings, patchy dermal ... more Ayoung lady was found to have hemihype rtrophy, scoliosis, subcutaneous swellings, patchy dermal hypoplasia, plantar hyperplasia and macrodactyly. These suggested a diagnosis of Proteus syndrome. She was also having unilateral generalized hypertrichosis. The association of Proteus syndrome and unilateral generalized hypertrichosis has not been reported in the literature.

and other aspects of factitious wealing (dermographism). Br J Dermatol 1971;85:331-5. 4. Kaplan A... more and other aspects of factitious wealing (dermographism). Br J Dermatol 1971;85:331-5. 4. Kaplan A.P., Clinical practice: Chronic urticaria and angioedema. N Engl J Med 2002;346:175-9. 5. Mathews CN, Kirby JD, James J, Warin RP. Dermographism: reduction in wheal sizeby chlorpheniramine and hydroxyzine. Br J Dermatolol 1973;88:279-82. 6. Ryan TJ, Shim-Young N, Turk JL, Delayed pressure urticaria. Br J Dermatol 1968;80:485-90. 7. Godse KV. Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol 2006;72:155-6. 8. Sukan M. The problems in sexual functions of vitiligo and chronic urticaria patients. J Sex Marital Ther 2007;33:55-64. 9. Estes SA, Yung CW. Delayed pressure urticaria: an investigation of some parameters of lesions induction. J Am Acad Dermatol 1981;5:25.

Nevus comedonicus (NC) is an uncommon variant of adnexal hamartoma, clinically appearing as confl... more Nevus comedonicus (NC) is an uncommon variant of adnexal hamartoma, clinically appearing as confluent clusters of open comedones. Some view it as a morphologic variant of epidermal nevus. When it is associated with non-cutaneous findings such as skeletal, CNS, or ocular abnormalities, it is termed as nevus comedonicus syndrome. Here we report a case of a 10-month-old infant with NC of external ear with recurrent inflammation.

A 41-year-old man with larva currens was diagnosed to have HIV infection. There was no evidence o... more A 41-year-old man with larva currens was diagnosed to have HIV infection. There was no evidence of hyperinfection with Strongyloides stercoralis. The effect of coexistent HIV infection in the natural course of strongyloidiasis is discussed.

A 42-year-old male developed hemorrhagic bullae and erosions while in alcohol induced coma. The l... more A 42-year-old male developed hemorrhagic bullae and erosions while in alcohol induced coma. The lesions were limited to areas of the body in prolonged contact with the ground in the comatose state. He developed rhabdomyolysis, progressing to acute renal failure (ARF). Histopathological examination of the skin showed spongiosis, intraepidermal vesicles, and necrosis of eccrine sweat glands with denudation of secretory epithelial lining cells. With supportive treatment and hemodialysis, the patient recovered in 3 weeks time. This is the fi rst reported case of bullous lesions and sweat gland necrosis occurring in alcohol-induced coma complicated by rhabdomyolysis and ARF. What was known? Bullous skin lesions and necrosis of eccrine sweat glands have been described in drug induced coma. The commonest reported cause is barbiturates; alcohol is a rare cause. A previously reported patient with alcohol induced coma and bullous skin lesions had biochemical evidence of rhabdomyolysis.

Context: Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation an... more Context: Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation and course of psoriasis. There is a paucity of data on this subject from India. Aims: To find out whether increased severity of psoriasis in adult Indian males is associated with tobacco smoking and alcohol use. Settings and Design: Cross-sectional study in the Department of Dermatology of a Tertiary Care Teaching Hospital. Subjects and Methods: Male patients above 18 years of age attending a psoriasis clinic between March 2007 and May 2009 were studied. Severity of psoriasis (measured using Psoriasis Area and Severity Index – PASI) among smokers and non-smokers was compared. We also studied the correlation between severity of psoriasis and nicotine dependence (measured using Fagerström Test for Nicotine Dependence) and alcohol use disorders (measured using Alcohol Use Disorders Identification Test– AUDIT). Statistical Analysis: Z‑test, Odd's ratio, Chi‑square test, Spearman's correlation coefficient. Results: Of a total of 338 patients, 148 were smokers and 173 used to consume alcohol. Mean PASI score of smokers was more than that of non-smokers (Z-test, z = −2.617, P = 0.009). Those with severe psoriasis were more likely to be smokers (χ 2 = 5.47, P = 0.02, OR = 1.8, Confidence Interval 1.09‑2.962). There was a significant correlation between PASI scores and Fagerström score (Spearman's correlation coefficient = 0.164, P < 0.01). Mean PASI scores of persons who used to consume alcohol and those who did not were comparable.(Z‑test, z = −0.458, P = 0.647). There was no association between severity of psoriasis and alcohol consumption.(χ 2 = 0.255, P = 0.613, Odds Ratio = 1.14, CI 0.696‑1.866). There was no correlation between PASI scores and AUDIT scores (Spearman's correlation coefficient = 0.024, P > 0.05). Conclusions: Increased severity of psoriasis among adult males is associated with tobacco smoking, but not with alcohol use.

2. Sullivan JR, Shear NH. The drug hypersensitivity syndrome: what is the pathogenesis?. Arch Der... more 2. Sullivan JR, Shear NH. The drug hypersensitivity syndrome: what is the pathogenesis?. Arch Dermatol 2001;137:357-64. 3. Sandra RK, Uetrecht J, Shear NH. Idiosyncratic drug reaction: the reactive metabolite syndromes.Lancet 2000;356:1587-91. 4. Brown RJ,Rother KI,Artman H,Mercurio MG,Wang R,Looney RJ et al. Minocycline-induced drug hypersensitivity syndrome followed by multiple autoimmune sequelae.

A 60-year old man with squamous cell carcinoma of hypopharynx and acrokeratosis paraneoplastica (... more A 60-year old man with squamous cell carcinoma of hypopharynx and acrokeratosis paraneoplastica (Bazex syndrome) is reported.

Context: Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation an... more Context: Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation and course of psoriasis. There is a
paucity of data on this subject from India. Aims: To find out whether increased severity of psoriasis in adult Indian males is associated
with tobacco smoking and alcohol use. Settings and Design: Cross‑sectional study in the Department of Dermatology of a Tertiary
Care Teaching Hospital. Subjects and Methods: Male patients above 18 years of age attending a psoriasis clinic between March 2007
and May 2009 were studied. Severity of psoriasis (measured using Psoriasis Area and Severity Index – PASI) among smokers and
non‑smokers was compared. We also studied the correlation between severity of psoriasis and nicotine dependence (measured using
Fagerström Test for Nicotine Dependence) and alcohol use disorders (measured using Alcohol Use Disorders Identification Test– AUDIT).
Statistical Analysis: Z‑test, Odd’s ratio, Chi‑square test, Spearman’s correlation coefficient. Results: Of a total of 338 patients,
148 were smokers and 173 used to consume alcohol. Mean PASI score of smokers was more than that of non‑smokers (Z‑test, z =
−2.617, P = 0.009). Those with severe psoriasis were more likely to be smokers (χ2 = 5.47, P = 0.02, OR = 1.8, Confidence Interval
1.09‑2.962). There was a significant correlation between PASI scores and Fagerström score (Spearman’s correlation coefficient = 0.164,
P < 0.01). Mean PASI scores of persons who used to consume alcohol and those who did not were comparable.(Z‑test, z = −0.458,
P = 0.647). There was no association between severity of psoriasis and alcohol consumption.(χ2 = 0.255, P = 0.613, Odds Ratio = 1.14,
CI 0.696‑1.866). There was no correlation between PASI scores and AUDIT scores (Spearman’s correlation coefficient = 0.024, P > 0.05).
Conclusions: Increased severity of psoriasis among adult males is associated with tobacco smoking, but not with alcohol use