Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant morbidity. Recognising the need for region-specific guidance, the Skin Allergy Research Society and Society for Eczema Studies have collaborated to develop updated, evidence-based guidelines tailored to the Indian context. These guidelines address AD management across all age groups, special populations while considering local epidemiology, healthcare infrastructure, and treatment accessibility. A structured Delphi consensus process was conducted among 23 dermatology experts over 3 months through virtual and in-person meetings. Literature from MEDLINE, Cochrane, and Google Scholar was systematically reviewed, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach was used to assess evidence quality. Clinical recommendations were refined through multiple voting rounds, leading to consensus statements. Recommendations are based on an extensive literature review up to December 2024. This document updates the 2019 Skin Allergy Society guidelines, reinforcing global recommendations while allowing local adaptability. These guidelines provide updated recommendations for topical, systemic, phototherapy, and biologic therapies in AD. Key advancements include the introduction of topical crisaborole and JAK inhibitors for mild to moderate AD, along with a focus on emerging systemic therapies, such as biologics and systemic JAK inhibitors. In the Indian context, the guidelines define the roles of dupilumab and abrocitinib while also addressing the off-label use of tofacitinib and baricitinib in resource-limited settings. Specific recommendations are provided for children, elderly patients, and pregnant women, emphasising safety considerations for systemic and biologic therapies. These guidelines align with global AD management while incorporating India-specific adaptations based on epidemiology, accessibility, and affordability. They serve as a key reference for dermatologists, pediatricians, and general practitioners in India and other resource-limited settings. Though tailored for India, they are also relevant to dermatologists in developing countries, guiding treatment selection based on disease patterns, environmental factors, and medication availability.
Introduction Critical thinking and clinical reasoning are two core competencies essential for medical students in their evolution from passive learners to proficient future clinicians. These competencies require higher-order cognitive skills which cannot be accomplished through conventional lectures. In contemporary medical education, team-based learning (TBL) has emerged as an active innovative instructional strategy which promotes active participation, accountability, problem-solving, and higher-order thinking. The California Critical Thinking Skills Test (CCTST) assesses critical thinking, while the Script Concordance Test (SCT) measures clinical reasoning under uncertainty. The study aimed to evaluate the effectiveness of TBL in improving critical thinking and clinical reasoning among first-year MBBS students. Method An educational interventional study was conducted among 152 first-year MBBS students during a TBL session which included their pre-class preparation, Individual Readiness Assurance Test (IRAT), Team Readiness Assurance Test (TRAT), and application exercises with immediate facilitator feedback. To assess critical thinking, a 20-item questionnaire called the Critical Thinking Assessment Test (CTAT) on adrenal cortex disorders was constructed based on the domains described in the CCTST. To measure clinical reasoning, a 30-item questionnaire was developed on the same topic based on SCT. The two questionnaires which were developed by the investigator and validated by an expert panel were used before and after the TBL session. Result A substantial improvement was observed in SCT (Cohen's d=0.89) in comparison to CTAT scores (Cohen's d=0.73) after the TBL session. The TBL intervention strengthened the relationship between clinical reasoning (SCT) and critical thinking (CTAT) transforming a weak correlation (r=0.163; p=0.045) into a moderate, statistically significant correlation (r=0.369; p<0.0001). Student performance increased progressively from IRAT (3.27±1.68) to TRAT (8.97±0.87) to application exercises (11.36±1.35) (p<0.0001). Conclusion The study indicates that the implementation of TBL sessions in the early stage of medical training of students can bridge the gap between basic science concepts and clinical applications enhancing both critical thinking and clinical reasoning.
Background: Procedural sedation of pediatric patients is necessary to minimize physical pain and psychological trauma and return the patients safely to their parents. Although ketamine and dexmedetomidine have been studied separately for minor surgical procedures, an ideal combination of doses of these two drugs through the intranasal route remains unclear. Aims and Objectives: The aim of the study was to compare the different dosage combinations of intranasal dexmedetomidine and intranasal ketamine that can be utilized for procedural sedation in pediatric patients undergoing surgeries in a day care setup to find a suitable dose combination for future use. The objectives of the study were to determine the degree of sedation at the time separation from the parents along with hemodynamic changes after drug instillation. Materials and Methods: A total of 60 pediatric patients scheduled for day care surgeries were randomized into two groups. Group DK1 received intranasal dexmedetomidine 1 mcg/kg combined with ketamine 5 mg/kg, whereas Group DK2 received intranasal dexmedetomidine 1 mcg/kg with ketamine 7 mg/kg. Sedation level and parental separation were assessed 30 min after drug administration using the parental separation anxiety scale (PSAS) and Ramsay sedation score. Results: The DK2 group had significantly better parental separation with a mean PSAS score of 1.6 compared to 2.6 in Group DK1 (P<0.001). Adequate sedation as assessed by Ramsay sedation score was achieved in 13 patients (43%) in DK1 and 22 patients (73%) in DK2. Conclusion: The study observed that dexmedetomidine with the higher dose of ketamine, in the pediatric age group, decreases the parental separation anxiety without serious clinical side effects.
Environmental stressors, including climate change, pollution, and lifestyle factors, can disrupt the skin barrier, leading to dryness and exacerbating conditions such as atopic dermatitis (AD), acne, and psoriasis. Effective barrier repair requires maintaining hydration and lipid balance, particularly the ceramide-cholesterol-fatty acid ratio of 3:1:1, which is recommended by dermatological societies for optimal skin restoration. Although traditional moisturizers provide hydration through occlusives, humectants, and emollients, they often do not achieve sustained barrier repair or adequate intracellular hydration. Next-generation moisturizers are designed with bioactive ingredients that aim to both hydrate and support barrier repair by reducing inflammation, modulating the microbiome, and promoting skin homeostasis. Oryza Ceramax (Alaina Healthcare; Alembic Pharmaceuticals Pvt. Ltd., Vadodara, India), a next-generation moisturizer incorporating a 3:1:1 ceramide-cholesterol-fatty acid ratio, includes aquaporin (AQP) boosters, naturally sourced betaine, saffron extract, hyaluronic acid, and other bioactive components that resemble the skin's natural lipid composition. Clinical evidence supports the efficacy of ceramide-dominant formulations in improving hydration and reducing transepidermal water loss (TEWL), with studies reporting TEWL reductions of approximately 10% and hydration improvement lasting up to 72 hours. Oryza Ceramax is formulated to align with dermatologic recommendations for use in dry or impaired skin and is free from parabens, alcohol, mineral oil, and soap (PAMS-free). Its formulation characteristics are consistent with evidence-based principles for skin barrier protection and hydration maintenance. This narrative review examines the science underlying multi-pathway approaches to skin barrier repair and hydration, using Oryza Ceramax as an example of a ceramide- and AQP-based formulation. The findings highlight emerging strategies in moisturizer design but also emphasize the need for independent, well-controlled clinical studies to validate these observations.
