Xeroderma Research Articles

Spirituality is Associated with Immune Parameters and Disease Activity in Primary Sjögren’s Syndrome: A Cross-Sectional Study

Introduction The role of spirituality in health and disease is a complex and emerging area of research. Incorporating spirituality into the bio-psycho-social model of health and disease leading to the bio-psycho-social-spiritual model provides a more comprehensive framework. In this context, chronic disorders like primary Sjögren’s syndrome (pSS) are of interest due to their intricate interactions between biological, psychological, and spiritual factors.ObjectivesTo study possible relationships between spirituality, immune parameters, and disease activity in pSS patients.Methods Patient recruitment for the study took place at the Autoimmune Sjögren specialty clinic, University of Debrecen, resulting in 112 patients. Assessing spirituality of the patients happened through 4 direct questions and the Sprituality Transcendence Scale (24 items). Besides, clinical data of the patients were involved in the study including blood cell counts, rheumatoid factor, immunoglobulin G, Sjögren-specific autoantibodies and disease activity scores (semi-objective and patient reported,). The statistical analysis was conducted applying group comparisons between spiritual and non-spiritual groups, and linear and logistic regression analyses adjusted for sex, age, disease duration, settlement type, education, living in partnership and smoking. Out of the 112 patients 4 gave incomplete response, and therefore got excluded from the analysis, resulting in a total sample size of 108.ResultsSemi-objective disease activity score (ESSDAI) and perceived vaginal dryness was significantly lower in the non-spiritual group. Spirituality was proven as a significant predictor of anti-SSB autoantibody serum activity and ESSDAI, while engaging in prayer/meditation and its duration predicted significantly anti-SSA autoantibody serum activity, perceived skin and tracheal dryness. Concerning logistic regression analysis, we found that an increase of one unit in spirituality reduces the probability with 81.6% of having a detectable, semi-objective disease activity at all. Significant associations were found between the duration of prayer/meditation and both semi-objective and patient reported disease activity scores and autoantibody anti-SSB with an inverse ratio based on logistic regression model.ConclusionsSpirituality is associated with immune parameters and disease activity in pSS. Patients with spiritual attitude are less likely to have increased disease activity. Besides being spiritual, engagement in individual spiritual activities, such as prayer/meditation has beneficial disease modifying effect. These changes are supposedly due to psychoneuroimmunological pathways. In addition to the biologically measurable variables, the alleviation and aggravation of perceived symptoms (e.g. dryness) are important outcomes of spiritual engagement and practice.Disclosure of InterestNone Declared

COVID-19 Protection Strategies: Lessons Learned About Epidermal Barrier Function and the Significance of Optimized Skin Care.

Initially categorized as primarily a respiratory disease, COVID-19 can involve other organ systems and may have direct skin manifestations, including exanthems, morbilliform eruption, generalized urticaria, or pseudo-chilblains —commonly called “COVID Toes.” Frequent handwashing and prolonged wearing of face masks and shields in efforts to minimize transmission of SARS-CoV-2, the novel coronavirus that causes COVID, has given rise to indirect skin manifestations of COVID. “Maskne” and handwashing dermatitis are particularly common among healthcare workers. Characterized by skin inflammation, dryness, pruritus, and other symptoms, these conditions are fundamentally disorders of skin barrier dysfunction. This dysfunction may result from the combination of mechanical skin damage, changes in skin pH, reductions in skin lipids attributable to protection measures, and local alterations in the cutaneous microbiome. Strategies to manage these conditions focus on reversing and repairing skin barrier damage with preventative general measures, optimized skin care with the selection of proper products, eliminating irritant exposures, and avoiding certain medications, such as topical corticosteroids, that may further impair barrier function despite temporary improvement in signs and symptoms. J Drugs Dermatol. 2024;23(4):  doi:10.36849/JDD.7862.

Photobiomodulation in the treatment of palmar–plantar erythrodysesthesia: a randomised controlled clinical study protocol

IntroductionHand–foot syndrome, also known as palmar–plantar erythrodysesthesia (PPE), is a complication caused by chemotherapy. Clinically, it manifests as erythema and oedema on the palms of the hands and feet, dry...

Atopic Dermatitis in Children.

Atopic dermatitis (AD) is extremely common in the pediatric population, and most children with AD will first present to their primary care provider (PCP). The PCP can recognize AD by its clinical features, including itch, a chronic relapsing course, and the characteristic eruption. The cornerstone of AD therapy is dry skin care, typically a short daily bath/shower followed by an emollient applied to all skin. Most children with AD will also require topical medications, such as topical corticosteroids and/or topical nonsteroidal therapies. For children with more severe disease, systemic agents, including several novel therapies, may be required. In managing AD, the clinician must monitor for side effects of medications as well as complications of the AD itself, the most common of which is secondary infection. An understanding of the pathogenesis, treatments, and complications of AD is essential for the PCP, as untreated (or undertreated) AD has a significant impact on the quality of life of affected children and their caregivers. [Pediatr Ann. 2024;53(4):e121-e128.].

THz radiation distribution for the identification of infiltrating ductal carcinoma in human breast model: a computational study

With numerous biomedical applications of terahertz (THz) imaging, spectroscopy, and sensing, the THz regime of the spectrum is quickly emerging as an important area of research with the potential to usher in a new era in the healthcare industry. In the medical field, THz radiation has been explored to diagnose and monitor several ailments, including foot diabetes, skin dryness, wounds, and burns. Compared to X-rays, THz waves' phase sensitivity to bodily fluid levels and water results in superior contrast and stronger absorption. This feature makes THz potentially useful for the diagnosis of various malignant tumor forms because cancerous tumors have higher water molecule contents than healthy tissues. The current study presents a computational analysis of a CW-THz point-by-point scanning technique for breast cancer detection. COMSOL multiphysics platform was utilized to create a multilayer three-dimensional breast model containing an irregular-shaped infiltrating ductal carcinoma in the glandular layer. The propagation of the THz radiation in the constructed breast model was simulated based on the radio frequency module and electromagnetic waves in the frequency domain interface. Furthermore, different volumes and locations of the induced tumor were examined. The results demonstrated significant disparities in the acquired electric distribution at different tumor sizes and sites between normal and diseased breasts. The resultant electric field for healthy breast ranged from 1.1 × 10–5 to 0.61 V/m, however, the electric field ranges following tumor addition fluctuate based on its volume and location. Additionally, the position of the THz source and detector array influences the reflected THz signal.

Synergetic Effects of Aloe Vera Extract with Trimethylglycine for Targeted Aquaporin 3 Regulation and Long-Term Skin Hydration.

Aquaporin 3 (AQP3) channels are tetrameric membrane-bound channels that facilitate the transport of water and other small solutes across cell membranes in the skin. Decreased AQP3 expression is associated with skin dryness, skin aging, psoriasis, and delayed wound healing. Thus, our study focused on a novel combination based on Aloe barbadensis leaf extract and trimethylglycine for targeted AQP3 regulation in skin keratinocytes and deep skin moisturization. Firstly, a dose-finding cytotoxicity assay of the selected substances was performed with a 2,5-diphenyl-2H-tetrazolium bromide (MTT) indicator on HaCaT cells. The substances' ability to increase the amount of AQP3 in keratinocytes was evaluated in a keratinocyte cell culture by means of ELISA. Additionally, the deep skin hydration effect was confirmed in clinical research with healthy volunteers. According to the results, the maximum tolerated doses providing viability at 70% (MTDs) values for Aloe barbadensis leaf extract and trimethylglycine were 24.50% and 39.00%, respectively. Following the research and development, a complex based on Aloe barbadensis leaf extract and trimethylglycine in a 1:1 mass ratio exhibited a good cytotoxicity profile, with an MTDs value of 37.90%. Furthermore, it was shown that the combination had a clear synergetic effect and significantly increased AQP3 by up to 380% compared to the negative control and glyceryl glucoside (p < 0.001). It was clinically confirmed that the developed shower gel containing Aloe barbadensis leaf extract and trimethylglycine safely improved skin hydration after one use and over 28 days. Thus, this novel plant-based combination has promising potential for AQP3 regulation in the skin epidermis and a role in the development of dermatological drugs for the treatment of skin xerosis and atopic-related conditions.

Skin barrier-inflammatory pathway is a driver of the psoriasis-atopic dermatitis transition.

As chronic inflammatory conditions driven by immune dysregulation are influenced by genetics and environment factors, psoriasis and atopic dermatitis (AD) have traditionally been considered to be distinct diseases characterized by different T cell responses. Psoriasis, associated with type 17 helper T (Th17)-mediated inflammation, presents as well-defined scaly plaques with minimal pruritus. AD, primarily linked to Th2-mediated inflammation, presents with poorly defined erythema, dry skin, and intense itching. However, psoriasis and AD may overlap or transition into one another spontaneously, independent of biological agent usage. Emerging evidence suggests that defects in skin barrier-related molecules interact with the polarization of T cells, which forms a skin barrier-inflammatory loop with them. This loop contributes to the chronicity of the primary disease or the transition between psoriasis and AD. This review aimed to elucidate the mechanisms underlying skin barrier defects in driving the overlap between psoriasis and AD. In this review, the importance of repairing the skin barrier was underscored, and the significance of tailoring biologic treatments based on individual immune status instead of solely adhering to the treatment guidelines for AD or psoriasis was emphasized.

Impact of modified ventilation strategies on water evaporation rate and thermal comfort in an indoor swimming pool by numerical study

The evaporation rate from a pool surface and the thermal comfort of bathers were evaluated numerically in a swimming pool enclosure in Canada while modifying the ventilation strategies, aiming to reduce trichloramine (NCl3) concentrations in the breathing zone. Air movement is required near the pool surface to remove NCl3 emanating from the water, but this airflow may cause unwanted thermal discomfort and water evaporation increase. A reference case based on the existing conditions and four simulated cases with varied ventilation strategies were evaluated to assess the impact on the water evaporation rate and thermal comfort. We implemented a water evaporation model in the Fire Dynamics Simulator (FDS) code to study how the modified airflow patterns may impact the evaporation rate. We also determined with a PMV modified index how thermal comfort of bathers with wet and dry skin is affected by the modified airflow of each case. Our findings show that adding deck level air extraction vents allow 41% NCl3 reduction without negatively impacting thermal comfort and with only a 4% water evaporation increase. Conversely, with commonly used dilution ventilation strategy and remaining within ASHRAE's recommendations for the airflow rate, we obtain only a 3% NCl3 reduction but up to 51% of dissatisfied bathers (with a local peak of 99%) for a “cool” environment. Water evaporation rate is also increased by 16%. Numerical airflow simulation is recommended as a tool to plan an optimal ventilation strategy balancing air quality, energy expenditure and thermal comfort in indoor aquatic environments.

Anticholinergic Toxidrome due to Thorn Apple Seed Ingestion in an Elderly Couple.

Sudden onset of reduced consciousness, psychomotor agitation and mydriasis are all indicative of an anticholinergic toxidrome. It is important to note that numerous drugs, as well as certain herbs and plants, possess anticholinergic properties. An 84-year-old female patient had sudden nocturnal onset of uncoordinated hand movements and altered mental status. Shortly after, the patient's 83-year-old husband developed symptoms of dysarthria, gait ataxia, vertigo, and delirium. Anticholinergic syndrome consists of a combination of central and peripheral anticholinergic symptoms. Physostigmine given intravenously resulted in rapid reversal of symptoms. Thorn apple seeds had been accidentally ingested and were identified as the cause. The clinical presentation of an anticholinergic toxidrome includes both central and peripheral symptoms such as altered consciousness, mydriasis, dry mucous membranes and skin, and tachycardia.Prompt recognition of anticholinergic toxidrome and the administration of physostigmine can lead to rapid reversal of symptoms and improved patient outcomes.Treatment with physostigmine is indicated when a patient with an agitated delirium does not respond adequately to titrated benzodiazepines.

A Comprehensive Review of Essential Oil–Nanotechnology Synergy for Advanced Dermocosmetic Delivery

This review investigates the convergence of nanotechnology and essential oils in advanced dermocosmetic delivery. It outlines the pivotal role of inorganic and polymeric nanoparticles, such as titanium dioxide, zinc oxide, and gold nanocarriers, in cosmeceutical applications, facilitating slow release, deeper skin penetration, and increased retention of active compounds. Essential oils, renowned for therapeutic benefits, face translation challenges due to volatility and low water solubility. This review explores the potential use of plant nanovesicles as carriers, emphasizing safety, stability, and scalability, offering a sustainable and cost-effective industrial application. Nanomaterial integration in consumer products, particularly cosmetics, is prevalent, with nanocarriers enhancing the permeation of bioactive compounds into deeper skin layers. The review emphasizes recent nanotechnological advancements, covering nanoparticle penetration, experimental models, and therapeutic applications in dermatology, ranging from non-invasive vaccination to transdermal drug delivery. Additionally, the review delves into nanomaterials’ role in addressing skin aging, focusing on tissue regeneration. Nanomaterials loaded with cosmeceuticals, such as phytochemicals and vitamins, are explored as promising solutions to mitigate signs of aging, including wrinkles and dry skin, providing innovative approaches to skin rejuvenation. Overall, the review offers a comprehensive synthesis of essential oil–nanoparticle synergy, shedding light on the current landscape and future potential of advanced dermocosmetic delivery systems.

Tannin and Iron-Reactive Phenolics Content in Red Cold-Hardy Hybrid Grape Tissues throughout Development and Ripening.

Phenolic compounds, especially tannins, are important for red wine quality. Wines made from cold-hardy hybrid grape cultivars have much lower tannin concentrations than wines from Vitis vinifera grape cultivars. This study assessed the phenolics content of berry tissues of three red cold-hardy hybrid cultivars in comparison to V. vinifera cv. 'Pinot noir' throughout development and ripening. Basic chemical properties, iron-reactive phenolics content, and tannin content were evaluated in the juice, skins, and seeds of Vitis spp. cvs. 'Crimson Pearl', 'Marquette', and 'Petite Pearl' and 'Pinot noir' at six time points from one week post-fruit set to harvest in 2021 and 2022. 'Crimson Pearl' displayed similar iron-reactive phenolics and tannin contents in juice, skins (22.6-25.4 mg/g dry skin and 8.0-12.2 mg/g dry skin, respectively), and seeds (12.8-29.8 mg/g dry seed and 4.2-22.0 mg/g dry seed, respectively) as 'Petite Pearl' and 'Marquette' at harvest in 2022. The hybrid cultivars showed a similar trend of phenolic accumulation as 'Pinot noir' but resulted in overall lower content in skins and seeds. Despite differences in developmental trends, the three hybrid grape cultivars displayed similar phenolic content at harvest ripeness. This is the first study examining the phenolic content of 'Crimson Pearl' and 'Petite Pearl' throughout berry development and ripening. This study provides important information for the wine industry to make informed decisions on making wine with these cultivars.

Risk factors of skin barrier dysfunction in older adults: A systematic review.

Skin barrier dysfunction can trigger various skin disorders in older adults. Skin barrier assessment is essential for nurses and caregivers to prevent skin disorders; however, the evidence available for clinical assessment is limited. This systematic review aimed to clarify the risk factors of skin barrier dysfunction in older adults. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The four databases were searched using multiple terms related to "aged" and "skin barrier." The search was initially run on April 19, 2023, and rerun on October 12, 2023. Peer-reviewed quantitative studies in English were included, with no publication time limit being set. Two reviewers assessed the risk of bias in a blinded and independent manner using JBI tools. Owing to the heterogeneity of the results, a narrative synthesis was performed. Among the database-identified 4833 studies, 20 studies were included. The extracted factors were categorized as demographic characteristics, functional characteristics, chronic diseases, nutritional status, skin condition, and environmental factors. However, owing to high risk of bias and inconsistent results across studies, only chronic kidney disease and dry skin were considered risk factors for skin barrier dysfunction in older adults. Assessment of chronic kidney disease and dry skin in daily skin care may guide the development of personalized skincare programs to maintain skin integrity in older adults. Furthermore, cohort studies that consider confounding factors and the reliability of measurements are needed for an in-depth investigation into skin barrier dysfunction and more risk factors.

Human IgE-FcεRI chip assay to screen natural products for antipruritic activity

A biochip assay provides high-throughput and multiplexed analysis of biological samples, chemicals, and natural products. Pruritus is itchiness due to several causes, such as allergy, dry skin, pregnancy, liver disease, kidney disease, and thyroid disease. Treatment of pruritus is associated with reduced immunoglobulin (IgE) and FcεRI levels in sera. Treatment of pruritus include corticosteroid creams or ointment. However, they have side effects, so we need a safer treatment using natural products. Here, we developed an assay using protein chip technology to identify natural products with antipruritic activity that inhibit IgE-FcεRI binding. Of the 28 tested natural product extracts, Corni Fructus extract inhibited human IgE-FcεRI binding and also showed anti-histamine effects in MC/9 mast cells. These results suggest that this protein biochip assay system can be used to identify promising natural product extracts for the treatment of pruritus.

Assessment of the Nutritional Status of Adolescents in Orphanage from Lahore, Pakistan

Orphans are one of the most vulnerable groups to nutritional deficiency, which require more nutritional care for proper growth and development. Assessment of nutritional status has cornerstone importance in orphans because growth retardation is mainly caused by undernutrition. As United Nations indicated in a recent report, there are more than 4.3 million orphan children in Pakistan and many of them are under age nearly of 17. The study aims to assess adolescent’s nutritional status and the relationship between BMI and their dietary habits. The current study is a cross-sectional study conducted on 80 orphan children aged (10-19 years). The sample of orphan children was taken from three orphanages in Lahore via non-probability convenient sampling. The data was collected using a questionnaire that included questions related to anthropometric measurements, clinical assessment, and food frequency tables. Data were analyzed by using SPSS software version 25. The frequency of orphans with normal BMI was 51.2% among the study sample. Indicatively, majority of children were suffering from paleness and dryness of skin, white spots in nails, redness in eyes, dry and brittle hair, and discolored or spongy gums. Dietary history showed that consumption of bread and cereals, starchy vegetables, junk food, and carbonated beverages was more common among orphanages. Orphan children in diverse orphanages had sub-clinical nutritional deficiencies due to poor dietary habits; emphasizing the need for detailed assessment of nutritional status in orphanages for the applications of related interventions to prevent nutritional deficiencies.

Xevinapant Combined with Pembrolizumab in Patients with Advanced, Pretreated, Colorectal and Pancreatic Cancer: Results of the Phase Ib/II CATRIPCA Trial.

Xevinapant is an orally available inhibitor of apoptosis proteins (IAP) inhibitor. Preclinical data suggest that IAP antagonism may synergize with immune checkpoint blockers by modulating the NFκB pathway in immune cells. Adult patients with non-high microsatellite instability advanced/metastatic pancreatic ductal adenocarcinoma (PDAC) or colorectal cancer were enrolled in this phase Ib/II study and received pembrolizumab 200 mg every 3 weeks intravenously, and ascending doses of oral xevinapant (100, 150, and 200 mg daily for 14 days on/7 days off). Dose escalation followed a 3+3 design with a 21-day dose-limiting toxicity (DLT) evaluation period. Following the determination of the recommended phase II dose (RP2D), 14 patients with PDAC and 14 patients with colorectal cancer were enrolled in expansion cohorts to assess preliminary efficacy. Forty-one patients (26 males) with a median age of 64 years were enrolled: 13 in the dose escalation and 28 in the two expansion cohorts. No DLT was observed during dose escalation. The RP2D was identified as xevinapant 200 mg/day + pembrolizumab 200 mg every 3 weeks. The most common adverse events (AE) were fatigue (37%), gastrointestinal AE (decreased appetite in 37%, nausea in 24%, stomatitis in 12%, and diarrhea and vomiting in 10% each), and cutaneous AE (pruritus, dry skin, and rash seen in 20%, 15%, and 15% of patients, respectively). The best overall response according to RECIST1.1 was partial response (confirmed) in 1 (3%), stable disease in 4 (10%), and progressive disease in 35 (88%). Xevinapant combined with pembrolizumab was well tolerated with no unexpected AEs. However, antitumor activity was low.

Lifetime prevalence and associated factors of itch with skin conditions: atopic dermatitis, psoriasis and dry skin in individuals aged > 50 years.

Itch, common in dermatological conditions, is often accompanied by psychological distress and reduced quality of life. However, research on the prevalence and associated factors of itch with skin conditions in general populations is limited. This cross-sectional study aimed to determine the lifetime prevalence of itch with skin conditions and to identify its associated factors in individuals aged > 50 years. Participants from the Rotterdam Study, a population-based cohort, were interviewed to assess whether they had ever had an itchy skin condition, defining lifetime itch with skin conditions. Over 20 demographic, lifestyle, dermatological and nondermatological factors were recorded. Multivariable logistic regression analysis explored associations between these factors and itch with skin conditions, reported as odds ratios (ORs) with 95% confidence intervals (CIs). In total, 5246 eligible participants were included (age range 51-100 years, median age 67; 56.0% women). The results revealed a-lifetime prevalence of 33.7% for itch with skin conditions. Factors significantly associated with itch were female sex (OR 1.26, 95% CI 1.11-1.43), body mass index (1.02, 1.01-1.03), self-reported atopic dermatitis (4.29, 3.74-4.92), presence of atopic dermatitis (1.97, 1.60-2.43), self--reported psoriasis (2.31, 1.77-3.01), presence of psoriasis (2.11, 1.55-2.87), self-reported dry skin (1.95, 1.73-2.20), self-reported asthma (1.40, 1.08-1.83), renal impairment (1.45, 1.17-1.79), and clinically relevant depressive (1.85, 1.52-2.25) and anxiety symptoms (1.36, 1.11-1.66). This study reveals a substantial one-third lifetime prevalence of itch with skin conditions in individuals aged > 50 years. Significant associations with diverse lifestyle, demographic, dermatological and, intriguingly, nondermatological factors, including renal impairment, imply additional contributors to induction or persistence of itch in individuals with skin conditions.

The Effect of the Symptom Level on the Illness Perception in Individuals Undergoing Hemodialysis

Purpose: This research was conducted to identify the effect of the symptom level on the illness perception in individuals undergoing hemodialysis. Material and Methods: The study was performed with 240 participants who had the hemodialysis procedure in dialysis units of hospitals and one private dialysis center in a province and satisfied the criteria to be included in the research. Results: In the study, it was found that nearly all patients experienced symptoms such as itching, numbness/tingling in the feet, feeling tired and dry skin. In the sample group that had a negative illness perception, it was found that the symptoms experienced alongside the hemodialysis procedure affected the illness perception, and there was a moderately positive relationship between these two variables. Conclusions: In this context, it was recommended that the frequency and the severity of symptoms of patients undergoing hemodialysis be regularly followed and these patients’ illness perception levels be evaluated. Key words: Illness perception, hemodialysis, symptom

A new bufadienolide from Bufo gargarizans Cantor

Bufo gargarizans Cantor (B. gargarizans) is the most widely distributed and abundant species of toad in China. Bufadienolides and indole alkaloids have cardiotonic and anti-tumor activities and are important pharmacological components of B. bufo gargarizans. In this experiment, a novel compound (1) and two known compounds (2 and 3) were isolated and identified from the dry skin of B. bufo gargarizans, both of which are bufadienolides. Various column chromatography methods were used to separate and purify the extract from the dried skin of B. bufo gargarizans. Accurate molecular weights were measured by HR-ESI-MS, and the chemical structure of the compounds was determined by NMR spectrometers. The structures were named as (2β,5β,16α)-2,5,16-trihydroxide bufa-14,20,22 dienolide (1), gamabufotalin (2) and desacetylbufotalin (3). In vitro cytotoxic activity assay indicated that compound 1 showed a moderate cytotoxicity against A549 cells with IC50 value of 12.65 μM.

Treatment of Anticholinergic Delirium with Oral Rivastigmine: A Case Report

BackgroundAnticholinergic toxicity is commonly encountered in the emergency department. However, the availability of physostigmine, a central acetylcholinesterase inhibitor used to reverse anticholinergic delirium, has been significantly limited due to national drug shortages in the United States. Several articles have explored the viability of rivastigmine as an alternative treatment for these patients. Case ReportA 33-year-old male presented to the emergency department after a suspected suicide attempt. The patient was found with an empty bottle of diphenhydramine at the scene. On arrival, he was tachycardic, delirious, with dilated and nonreactive pupils and dry skin. As the clinical picture was highly suggestive of anticholinergic toxicity, the patient was treated with oral rivastigmine at a starting dose of 4.5mg to reverse his anticholinergic delirium. Though requiring a repeat dose, his delirium resolved without recurrence.Why Should an Emergency Physician Be Aware of This? Oral rivastigmine has been successfully applied here and in other case reports to reverse anticholinergic delirium with the benefit of prolonged agitation control. Emergency physicians may consider this medication in consultation with a specialist, with initial doses starting at 4.5 to 6 mg, if encountering anticholinergic delirium when physostigmine is not available.

WARNA TERHADAP KENYAMANAN RUANG AVISHA WELLNESS &amp; SPA JIMBARAN, BALI

The development of life every year, every day always experiences changes both in terms of technology, needs and desires. From the point of view of needs, many young people, especially women, are now trending about body beauty to avoid wrinkles, dry skin and stay young. To fulfill their desires, alternatives are needed for their needs, one of the alternatives to this problem is to undergo therapy at a spa. It is necessary to pay attention to a comfortable and safe place to carry out therapy. One of the comforts of the therapy place is the color combination of the place. With the right combination of colors in the room, visitors will feel comfortable and can pamper their eyes so they can achieve good relaxation.