Vitamin C Deficiency Masquerading as Vasculitis in a Patient With Crohn's Disease

This case study features a 40-year-old male with Crohn's disease (CD) who was initially misdiagnosed with vasculitis but was later shown to have scurvy owing to vitamin C deficiency. The patient's diet was nearly exclusively made up of highly processed fast food, with no fresh fruits or vegetables. A mildly sensitive, violaceous rash on his lower legs, mild gingival hemorrhage and enlargement, and muscle soreness were among his symptoms. Anemia and undetectable vitamin C levels were discovered in laboratory studies. A skin sample revealed follicular hyperkeratosis, coiled hairs, and perifollicular bleeding, eliminating the possibility of vasculitis. Scurvy was confirmed by undetectable vitamin C levels and intramuscular bleeding discovered during a muscle biopsy. After one month of vitamin C administration, the patient's skin was entirely clear. This instance emphasizes the significance of taking vitamin C insufficiency into account in patients with CD and other disorders that can cause malabsorption. Misdiagnosis might result in unneeded treatments and medical expenses. Scurvy must be diagnosed as soon as possible because it might cause gastrointestinal/intracerebral hemorrhage and death.

Nationwide Case-Control Analysis of Merkel Cell Carcinoma and Associated Skin Cancer Comorbidities: An Examination of the All of Us Database

Introduction Merkel cell carcinoma is an aggressive neuroendocrine tumor that is related to immunosuppression and the Merkel cell polyomavirus. It is more common on the head and neck and has been associated with other skin malignancies such as basal cell carcinoma, squamous cell carcinoma, and melanoma. However, there has never been a nationwide investigation that quantifies Merkel cell carcinoma's connection with these subgroups. Methods Utilizing the National Institutes of Health's All of Us open-access database, a retrospective study was conducted by filtering for Merkel cell carcinoma through the International Classification of Diseases, 9th and 10th Clinical Modification codes 209.* and C4A.*, respectively. This led to the inclusion of 41 patients in the study, with each instance compared to four control patients without merkel cell carcinoma, matched by age, race, and gender. The data's demographics and skin cancer co-morbidities were collected and evaluated with odds ratios and 95% confidence intervals using Wald's method. Results In patients with merkel cell carcinoma, a statistically significant gradient of increasing risk for developing basal cell carcinoma (Odds Ratio, 11.63; 95% Confidence Interval, 4.30-31.45; P < 0.0001), squamous cell carcinoma (Odds Ratio, 15.09; 95% Confidence Interval, 3.87-58.84; P = 0.0001), and melanoma (Odds Ratio, 27.94; 95% Confidence Interval, 3.26-239.48; P = 0.0024) was observed. The race/ethnicity demographics showed that 85.4% of the patients were white, and they were at the highest risk of developing merkel cell carcinoma. However, the study has limitations, such as the inability to identify the stage of merkel cell carcinoma among patients and the lack of consideration for other confounding variables. Conclusion The study examines the link between merkel cell carcinoma and other skin malignancies, underscoring the need for more national research to better understand the underlying causes that contribute to this link. The findings also indicate the possibility of sample bias in the All of Us database, emphasizing the need to assess the patient population's representativeness in such investigations.

Avelumab for Advanced Merkel Cell Carcinoma: Global Real-World Data on Patient Response and Survival

Introduction

Avelumab is a programmed cell death-ligand 1 (PD-L1) inhibitor approved by the Food and Drug Administration for advanced Merkel cell carcinoma (MCC). Studies conducted in real-world settings have shed light on its effectiveness and safety in clinical settings.

Areas Covered

Real-world studies on avelumab for MCC from North and South America, Europe, and Asia have been presented in this review. Most studies are on patients over age 70 and have a male-predominant sex ratio. Overall response rates range from 29.1% to 72.1%, (disease control rate: 60.0-72.7%; complete response rate: 15.8%-37.2%; partial rate: 18.2-42.1%; stable disease: 7.1-30.9%; progressive disease: 7.1-40.0%) and median progression free survival ranges from 8.1 to 24.1 months depending on the population studied. Immunosuppressed patients appear to benefit from avelumab as well, with response rates equivalent to the general population. Patients receiving avelumab as a first-line agent tend to have better outcomes than those using it as a second-line therapy. Fatigue, infusion-related reactions, and dyspnea were some of the most common adverse events identified in real-world studies. Autoimmune hepatitis and thyroiditis were also observed.

Conclusion

The use of avelumab as a safe and effective treatment option for advanced MCC is supported by real-world data, although additional study is required to assess long-term efficacy and safety outcomes.

Sclerotherapy off the Lower Extremities: A Single-Center Retrospective Study of Veins Treated on the Dorsal Hands and Chest

BACKGROUND

Few studies have evaluated the safety and efficacy of treatment of cosmetic dorsal hand and chest/breast veins.

OBJECTIVE

To retrospectively evaluate results of dorsal hand and chest vein foam sclerotherapy.

MATERIALS AND METHODS

A retrospective chart review of dorsal hand and chest vein sclerotherapy patients at a dermatology practice was performed between January 2014 and April 2023.

RESULTS

Fifty-five patients (54 female and 1 male patients) with a mean age of 55.8 ± 10.5 (31-83) years underwent treatment. Mean number of sessions for dorsal hand ( n = 41) and chest ( n = 14) patients were 1.5 ± 0.9 (1-5) and 1.6 ± 1.2 (1-5), respectively. Both groups were predominantly treated with 0.2% sodium tetradecyl sulfate or 0.5% polidocanol foam. Rate of coagulum formation across all sessions in the dorsal hands and chest was 15.2% and 3.0%, respectively. Vein induration, edema, postsclerotherapy hyperpigmentation, and persistent erythema were rarely seen. No patients experienced superficial venous thrombophlebitis, erosion/ulceration, telangiectatic matting, or neurologic side effects. Seventy-five percent and 63.2% of chest and hand patients, respectively, demonstrated significant clinical improvement at 3-month follow-up, although not systematically evaluated.

CONCLUSION

Foam sclerotherapy of dorsal hand and chest veins with detergent sclerosing agents is safe and effective with mild, self-limited adverse events.

Calcium Hydroxylapatite-Induced Inflammatory Facial Edema and Induration Due to Hashimoto's Thyroiditis

We describe a patient who experienced a diffuse, treatment-refractory facial inflammatory reaction following the injection of calcium hydroxylapatite with lidocaine. The reaction was attributed to undiagnosed Hashimoto's thyroiditis. Exogenous thyroid hormone replacement therapy rapidly resolved the facial inflammation associated with this type of autoimmune hypothyroidism.

Heat ameliorative measures in Murrah buffalo (Bubalus bubalis) heifers during summer: effect on microclimate, thermal comfort, and behavior

Water buffalo (Bubalus bubalis) is the mainstay of milk production in Asian countries including India. However, the hot climate of the country remains the biggest bottleneck to exploit the potential of this species. Therefore, a study was conducted to assess the effect of heat ameliorative measures on microclimate, thermal comfort, and behavior of Murrah buffalo heifers during summer. Buffalo heifers (n = 24) between the age of 15 and 20 months with a mean body weight of 363.75 ± 11.27 kg were randomly grouped into four treatments based on their age and body weight. The heifers kept in the shed without any cooling served as CON (control), while the animals of group CJ were tied with a cooling jacket. The buffalo heifers of the CJF group were subjected to the cooling jacket with forced air ventilation, whereas the intermittent (10 min at 2-h intervals) sprinkling followed by forced air ventilation was practiced in group SF between 900 and 1800 h throughout the experiment. The microclimatic variables were low in the sheds of groups CJ, CJF, and SF than the CON. The physiological responses such as rectal temperature, skin temperature, respiration rate, and pulse rate were reduced in groups CJ, CJF, and SF than the CON at 1400 h. The serum cortisol was less in the CJF and SF than those of CON group. The animals of the CJ, CJF, and SF groups spent more time for feeding and rumination with less frequent longer bouts. The extended periods of lying followed by shorter standing and idling were observed in groups CJ, CJF, and SF when compared with the CON. It may be therefore concluded that cooling jacket and intermittent sprinkling in combination with forced air ventilation might be helpful in improving the micro-environment, thermal comfort, and behavior of buffalo heifers particularly under tropical climates during summer.

Tuning the interface in epoxy-based composites and laminates through epoxy grafted graphene oxide enhances mechanical properties

Improved dispersion together with enhanced interfacial adhesion of the reinforcement is the key to superior structural properties in polymer nanocomposites. Herein, graphene oxide (GO) is employed to reinforce epoxy, and in order to improve the interfacial adhesion, epoxy chains were grafted directly onto GO prior to composite preparation. The functionalized GO sheets were systematically characterized using FTIR, TEM, Raman spectroscopy, XRD, and XPS. The epoxy composites with GO and epoxy grafted graphene oxide (Ep-g-GO) were prepared with the addition of only a small amount (0.5 wt%) of GO using a mechanical stirrer coupled to a bath sonicator. This strategy resulted in an impressive increase in mechanical properties, 40% in storage modulus, 70% in hardness, 39% in fracture toughness, and 8% in tensile strength, as compared to neat epoxy. In addition, the modified composites were thermally stable up to 300 °C as inferred from the thermogravimetric analysis. The enhanced properties of the composites further led to investigating the effect of Ep-g-GO on epoxy/carbon fiber (CF) laminates. Interestingly, incorporation of 0.5 wt% Ep-g-GO resulted in improved interfacial adhesion between GO and the epoxy matrix, which enhanced the tensile strength by 12% and inter-laminar shear strength by 9% as compared to neat epoxy/CF laminates. This study clearly demonstrates the positive effect of the tailored interface, offered by Ep-g-GO, on the mechanical properties of epoxy composites and epoxy/CF laminates.

Liver stiffness by magnetic resonance elastography is associated with increased risk of cardiovascular disease in patients with non-alcoholic fatty liver disease

BACKGROUND

Magnetic resonance elastography (MRE) is a reliable non-invasive alternative to liver biopsy for assessing liver fibrosis. There are limited data regarding an association between liver fibrosis by MRE and risk of cardiovascular disease (CVD).

AIM

To investigate the association of high-risk CVD phenotype determined by coronary artery calcification (CAC) with liver fibrosis by MRE in patients with non-alcoholic fatty liver disease (NAFLD).

METHOD

This was a cross-sectional analysis of well-characterised, prospective cohorts including 105 patients with NAFLD (MR imaging-derived proton density fat fraction ≥ 5%) with contemporaneous cardiac computed tomography (CT) and MRE. Patients were assessed using MRE for liver stiffness, and cardiac CT for the presence of CAC (defined as coronary artery calcium score > 0). Odds of presence of CAC were analysed using logistic regression analysis.

RESULTS

The average age and body mass index were 54.9 years and 32.9 kg/m² respectively. In this cohort, 49.5% of patients had CAC and 35.2% had significant liver fibrosis (defined as MRE ≥2.97 kPa). Compared to patients without CAC, those with CAC were older (50.0 [39.0-59.0] vs 63.0 [55.5-67.5], P < 0.001) and had higher Framingham risk score (FRS, 1.0 [0.5-3.5] vs 6.0 [2.0-12.0], P < 0.001). In multivariable-adjusted analysis, liver stiffness as a continuous trait on MRE was independently associated with the presence of CAC in a sex and age-adjusted model (adjusted odd ratios [aOR] = 2.23, 95% confidence interval [CI] = 1.31-4.34, P = 0.007) as well as in a FRS-adjusted model (aOR = 2.16, 95% CI = 1.29-4.09, P = 0.008). When analysed as a dichotomous trait, significant fibrosis (MRE-stiffness ≥2.97 kPa) remained independently associated with the presence of CAC in both FRS-adjusted model and sex and age-adjusted model (aOR = 3.21-3.53, P = 0.013-0.017). In addition, CAC was more prevalent in patients with significant fibrosis than those without as determined by MRE (67.6% vs 39.7%, P = 0.012).

CONCLUSION

Liver stiffness determined by MRE is an independent predictor for the presence of CAC in patients with NAFLD. Patients with NAFLD and significant fibrosis by MRE should be considered for further cardiovascular risk assessment, regardless of their FRS.

Nematicidal effect of cruciferous bio-fumigants against the root-knot nematode, Meloidogyne incognita infesting okra

In Haryana, India, only carbofuran is registered for the management of root-knot nematodes. The objective of this study was to investigate the potential of cruciferous bio-fumigants for the management of root-knot nematodes (Meloidogyne incognita) in okra. The experiments were conducted at research area Department of Nematology in 2017 to 2018 and 2018 to 2019. During this investigation, cruciferous bio-fumigants such as cabbage leaves and cauliflower leaves were used as bio-fumigant sources to protect Okra cv. Hisar Unnat. Fresh and chopped leaf mass of cabbage and cauliflower was incorporated uniformly into a naturally infested field. The initial nematode population in both years was 224 and 256 J₂/200 cc soil, respectively. The results of our investigation showed that in both the years okra yield was enhanced significantly by the measures of nematode management. In addition, both of the tested bio-fumigant plants leaves proved to be potentially promising for the management of root-knot nematodes. Among the bio-fumigants, the highest decrease in nematode population, root gall index and increase in yield was observed in cabbage leaves @ 50 t/ha in both years, consecutively.

Endoxifen, a New Treatment Option for Mania: A Double-Blind, Active-Controlled Trial Demonstrates the Antimanic Efficacy of Endoxifen

The protein kinase C (PKC) signaling system plays a role in mood disorders and PKC inhibitors such as endoxifen may be an innovative medicine for bipolar disorder (BP) patients. In this study we show for the first time the antimanic properties of endoxifen in patients with bipolar I disorder (BPD I) with current manic or mixed episode. In a double-blind, active-controlled study, 84 subjects with BPD I were randomly assigned to receive endoxifen (4 mg/day or 8 mg/day) or divalproex in a 2:1 ratio. Patients orally administered 4 mg/day or 8 mg/day endoxifen showed significant improvement in mania assessed by the Young Mania Rating Scale as early as 4 days. The effect remained significant throughout the 21-day period. At study end point, response rates were 44.44% and 64.29% at 4 mg/day and 8 mg/day of endoxifen treatment, respectively. Thus, endoxifen has been shown as a promising novel antimanic or mood stabilizing agent.

Study of short lactation in Sahiwal cattle at organized farm

Aim:

The aim was to study the associated factors and extent of short lactations in Sahiwal cattle maintained under organized herd.

Materials and Methods:

The present study was conducted on Sahiwal cattle (n=530), utilizing 1724 lactation records with respect to lactation length (LL), spread over a period of 15 years (1997-2011), maintained at Livestock Research Center, National Dairy Research Institute, Karnal. Observations of LL were analyzed by descriptive statistical analysis in order to know the extent of short lactation of animals in the herd. Paternal Half sib method was used to estimate the genetic parameters, i.e., heritability, genetic, and phenotypic correlation. The influence of various non-genetic factors (season of calving, the period of calving, parity, type of calving, and season of drying) on LL was studied by least squares analysis of variance technique.

Results:

The least squares means for LL was found to be 215.83±3.08 days. Only 32.48% of total lactation records were fell in the range of 251-350 days of LL, while more than three-fourth (76%) of total observations were failed to reach the standard level of 305 milking days. LL class ranges from 251 to 300 days accommodated maximum number of observations (19.2%). The heritability estimate of LL was 0.22±0.07. Positive correlations were found between LL and service period, LL and 305 or less days milk yield, LL and calving interval; whereas dry period was negatively correlated with the LL. The least squares analysis had shown that LL was significantly (p<0.01) influenced by the period of calving, type of calving, and season of drying. Significantly higher LL (276.50±7.21 days) was found in animals calved in the first period than those calved in other periods. The cows dried during summer season had the shortest LL (188.48±7.68 days) as compared to other seasons.

Conclusion:

Present findings regarding short lactations occurrence may be alarming for the indigenous herd, demanding comprehensive study with the larger data set. Since LL was influenced by various environmental factors suggesting better managerial tools, besides special attention on the milch animals going to dry during the summer season.

Augmented telomerase activity and reduced telomere length in parthenium-induced contact dermatitis

BACKGROUND

Parthenium dermatitis is a common chronic inflammatory disease with activated T lymphocytes that recognize the antigens, which leads to proliferation and differentiation. Telomeres and telomerase play an important role in the regulation of life span of the cell. Telomere length maintained by telomerase, are specialized repeats present at the end of chromosomes which protect it from degradation, end-to-end fusion and are important for integrity of chromosomes.

OBJECTIVES

The aim of this study was to measure telomerase activity and telomere length in Peripheral blood mononuclear cell (PBMC), CD4(+) and CD8(+) T lymphocytes from parthenium dermatitis patients.

METHODS

The study includes 50 patients of parthenium dermatitis confirmed by patch testing and 50 healthy controls. Telomerase activity was measured using the telomere repeat amplification protocol using PCR-ELISA kit. Telomere length was measured by using Telo TAGGG Telomere Length Assay Kit.

RESULTS

Significantly elevated levels of telomerase activity was observed in PBMC, CD4(+) and CD8(+) T cells of parthenium dermatitis patients as compared with healthy controls. However, significantly reduced telomere length in PBMC, CD4(+) and CD8(+) T cells have been found in patients than healthy subjects, but there was no difference between CD4(+) and CD8(+) T cells in patients.

CONCLUSION

This study might have provided insight into the role of telomerase in parthenium dermatitis that is characterized by the recruitment of T lymphocytes, which play an important role in this inflammatory disease. The augmented telomerase activity and reduced terminal restriction fragment length might be explored as a potential diagnostic/prognostic marker for parthenium dermatitis in future.

Total skin electron irradiation treatment for mycosis fungoides with a new alternate daily treatment schedule to minimize radiation-associated toxicity: a preliminary experience

Conventional total skin electron irradiation (TSEI) for mycosis fungoides (MF) causes radiation toxicity, requiring treatment interruptions that prolong the treatment period, making patient compliance poor. We evaluated an alternate daily treatment schedule of TSEI, using a high dose rate (HDR) to minimize radiation toxicity and shorten the treatment duration. Four patients (aged 45-73 years with MF duration of 7-22 months) were treated by TSEI using HDR. The treatment was given on 5 days/week for 2 weeks followed by treatment on alternate days to deliver a total dose of 36 Gy. All the patients completed treatment in 10 weeks and had complete remission. Radiation toxicity was much less common with this schedule, requiring no treatment interruption. All the patients were until in remission after 60-84 months of follow-up. This schedule of TSEI treatment caused minimal radiation toxicity and allowed completion of treatment over a shorter period, giving good clinical remission and prolonged disease-free survival.

Intralesional immunotherapy with killed Mycobacterium w vaccine for the treatment of ano-genital warts: an open label pilot study

BACKGROUND

Intralesional immunotherapy with skin test antigens and vaccines has been found to be effective in the management of genital and extragenital warts.

OBJECTIVE

To evaluate the efficacy and safety of intralesional Mycobacterium w (Mw) vaccine monotherapy for the treatment of ano-genital warts.

PATIENTS AND METHODS

Ten patients clinically diagnosed to have external ano-genital warts, including three with giant ano-genital warts (Buschke Löwenstein tumour), were included in this open-label pilot study. Two patients were human immunodeficiency virus seropositive, and one was on iatrogenic immunosuppression for renal transplantation. Mw vaccine (0.1 mL) was initially injected intradermally in the deltoid region on both the sides, followed 2 weeks later by intradermal intralesional injection into the genital warts. Intralesional injections were repeated weekly until either complete clearance or a maximum of 10 injections was achieved.

RESULTS

One patient was lost to follow-up after the first intralesional injection. In 8 out of remaining 9 patients (88.9%), the genital warts cleared completely. In one patient with giant perianal wart, the lesion was reduced to less than 5% of its volume after 10 intralesional injections, which was later electrosurgically excised. The treatment was well tolerated by the majority of the patients. The adverse reactions were noted in four patients, which were reversible. No recurrence was seen after a mean follow-up of 5.1 months.

CONCLUSION

Intralesional immunotherapy of ano-genital warts with Mw vaccine seems to be a promising new approach, which needs to be evaluated in the randomized controlled trials.

Combretastatin a-4 analogs as anticancer agents

Combretastatin A-4 (CA-4) is one of the most potent antimitotic and antiangiogenic agents of natural origin. It has displayed potent antitumor effect in a wide variety of preclinical tumor models. Till date various CA-4 analogs have been synthesized and evaluated for anticancer activity. This review is an attempt to compile the medicinal chemistry of various synthesized CA-4 analogs.

Bilateral brachial plexopathy as an initial presentation in a newly-diagnosed, uncontrolled case of diabetes mellitus

A 55-year-old Indian woman with newly-diagnosed diabetes mellitus presented with acute onset right upper limb proximal weakness. This was followed three weeks later by pain, weakness and sensory loss in the left upper limb. Electrodiagnosis showed patchy multiple proximal and distal axonal neuropathies in both upper limbs, consistent with bilateral brachial neuritis. Laboratory investigations, cerebrospinal fluid analysis, and imaging studies were normal except for an antinuclear antibody titre of 1:640. Sural nerve and quadriceps biopsy did not show vasculitis. Brachial plexopathy has seldom been associated with diabetes mellitus and could represent a rare subtype of the diabetic neuropathies.

Profile of psychiatric disorders and life events in medically ill elderly: experiences from geriatric clinic in Northern India

BACKGROUND

Morbidity among elderly people has an important influence on their psychological well-being. Evaluation of the morbidity profile and its determinants, which have implications for management of medical problems of elderly people, are scarce in developing countries. Even the physicians' detection rate of mental distress in elderly populations is low in medical outpatient clinics. This could be due to the large caseloads and also, importantly, underestimation of psychological concerns of the elderly. The objective of this study was to study the psychiatric co-morbidity and life events among elderly medical outpatients.

METHODS

One hundred medically ill elderly (>60 years) patients attending the Geriatric Clinic at Bikaner (North India) constituted the study population. The physical diagnosis was made by a physician based on reported illness, clinical examination and medical records. Psychiatric diagnosis was made by detailed clinical psychiatric interview using ICD-10 guidelines. Life events were assessed by the Indian adaptation of Presumptive Stressful Life Events Scale.

RESULTS

Hypertension was the most commonly reported physical diagnosis (50%), other specific medical illnesses were osteoarthritis (15%), diabetes (13%) and constipation (8%). The study found 18% subjects had depression and 11% had other mental disorders. Patients with mental disorders had suffered more recent stressful life events. Among life events, conflicts in family (16%); unemployment of self or children (9%) was reported by elderly psychiatric patients. Other reported life events in psychiatric diagnosed elderly were conflict in family (7%), illness of self (6%) or family members (5%) and death of family members (5%) or close relatives (4%).

CONCLUSION

Mental disorders are common among medically ill elderly patients, but they are poorly recognized and treated. Assessment of the psychiatric morbidity will help in strengthening psycho-geriatric services and thus, improve the quality of life of the elderly.

Clinical profile, electrodiagnosis and outcome in patients with carpal tunnel syndrome: a Singapore perspective

INTRODUCTION

Carpal tunnel syndrome (CTS ) is the most common entrapment neuropathy seen in our neurodiagnostic laboratory referrals. We describe the clinical profile, and outcome in patients with electrophysiological diagnosis of CTS seen in our centre over a six month period.

METHODS

A retrospective study was carried out and included 134 consecutive patients with CTS referred to the Neurodiagnostic Laboratory, National Neuroscience Institute, from October 2003 to March 2004, for the confirmatory testing. Severity grade was assigned following American Association of Electrodiagnostic Medicine criteria of CTS.

RESULTS

The majority of patients were female (81.3 percent) with mean age of presentation being 53.6 years. Chinese women constitute the majority racial group. Paraesthesia (70.1 percent) and numbness (19.4 percent) were the presenting sensory symptoms. In the nerve conduction study, 108 patients had bilateral CTS with 35 having unilateral symptoms. Dominant hand involvement was present in 92.3 percent. Overall, 40.3 percent had mild, 46.3 percent had moderate and 13.4 percent had severe CTS, with median duration of symptoms of two, four and 12 months, respectively. Follow-up data were available for 115 patients. 27 patients with surgical treatment showed resolution or improvement in 53.3 percent with moderate CTS, and 83.3 percent with severe CTS, at three-month follow-up. 14 patients turned up for six-month follow-up and 92.9 percent showed improvement in symptoms. 88 patients were managed conservatively; symptoms were unchanged or worsened in 80.6 percent with mild CTS, 65.9 percent with moderate CTS, and 62.5 percent with severe CTS at three-month follow-up. Of the 54 patients who turned up for six-month follow-up, the clinical symptom remain unchanged or worsened in 68.5 percent.

CONCLUSION

The severity of CTS is associated with longer duration of symptoms. Sensory symptoms and dominant hand involvement is more common. There is a high default rate in the clinical follow-up. Early surgical intervention results in either resolution or improvement in symptoms, whereas conservative management does not affect the natural history with symptoms that persisted or worsened with time.

Neurofibromatosis I with unusual hypopigmentation masquerading as leprosy

A case of Neurofibromatosis I (NFI) occurring in association with symmetrical peripheral nerve enlargement and multiple hypopigmented macules strikingly limited to the neurofibromas, with normal to minimally reduced sensations, evoking a strong clinical suspicion of co-existent lepromatous leprosy, is being reported. Leprosy was ruled out by microbiological, histopathological and electrophysiological studies. The case is interesting in view of the hypopigmented macules overlying the neurofibromas, which is an unreported feature of NFI.

Childhood leprosy in eastern Nepal: a hospital-based study

A hospital-based retrospective study on childhood leprosy was carried out at B.R. Koirala Institute of Health Sciences, Dharan, covering the period April 1998-April 2002. 20 (4.45%) leprosy patients were detected in children aged 6-14 years. The male:female ratio was 4:1. History of contact was found in 10% of the patients. The commonest type of leprosy was borderline tuberculoid leprosy (550%), followed by borderline lepromatous leprosy (301%). Most of the patients had more than one lesion. Nerve involvement and grade 2 deformity were noted in 55% and 20% of the patients respectively. Slit skin smear was positive in 30% of patients.

Panniculitides--a clinicopathologic study

OBJECTIVES

To describe the clinical and pathologic features of panniculitides, an uncommon group of diseases, where the available Indian literature is sparse.

MATERIAL AND METHODS

Prospective four years study of patients presenting with panniculitis to a large teaching hospital in North India.

RESULTS

Erythema nodosum (EN) was the commonest panniculitis (79.3% cases) in our cohort. Other causes included erythema induratum, Weber Christian disease, cutaneous polyarteritis nodosa and panniculitis associated with Takayasu's arteritis and dermatomyositis-lupus overlap. Elevated ESR and leukocytosis were the common laboratory abnormalities encountered. Septal panniculitis without vasculitis was the most frequent histopathologic pattern observed. Patients of EN did well on nonsteroidal anti-inflammatory drugs while corticosteroids with or without azathioprine were used to treat other panniculitides.

CONCLUSIONS

Physician awareness, clinical pattern recognition and histopathological confirmation, all play a key role in the identification and management of panniculitis.

Determination of lacidipine from urine by HPTLC using off-line SPE

A simple, rapid and sensitive high performance thin layer chromatographic method was developed and validated for the estimation of lacidipine. The sample preparation involved protein precipitation followed by an efficient solid phase extraction on C18 cartridge. The analytes were isolated from 1 ml of urine and recovered by pure ethyl acetate solution. The method employed TLC aluminium plate precoated with silica gel 60F254 as the stationary phase. The solvent system employed consists of toulene-ethyl acetate [6.5:3.5v/v]. This system gave a dense and compact spot of the drug at R(f) value of 0.45. The linear regression data for the calibration plots showed good linear relationship (r=0.999) over the concentration range 10-80 ng. Recovery studies were performed at two different levels. The recovery data reveals that the R.S.D. for intra-day and inter-day analysis at 10 ng was found to be 0.84 and 0.22%, respectively. The proposed method was found to be useful for the routine analysis of pharmaceuticals and pharmacokinetic studies in human urine samples.

Long term topical application of lactic acid/lactate lotion as a preventive treatment for acne vulgaris

In an open clinical study, efficacy of 5% aqueous solution of lactate for preventing acne was evaluated in 22 patients. Lactate lotion was used topically all over the face twice a day and continued like a cosmetic for 1 year. Systematic antibiotics were given for periods of 4 weeks whenever the disease was severe. The effect of the treatment was evaluated by counting the number of comedones, inflammatory lesions and cysts separately once a month and recording them graphically. The greatest reduction in the lesion counts was achieved in 8-24 weeks for the inflammatory lesions and 8-30 weeks for the comedones. At the end of 1 year 90-100% reduction of the inflammatory lesions was achieved in 40.9% patients and non-inflammatory lesions in 22.7% patients. The remaining patients showed 50-90% reduction, while 2 patients showed less than 50% reduction in the non-inflammatory lesions. Thus, most of the patients showed significant reduction in the lesion counts. Aggravations were associated with the hot and the rainy season and required concomitant treatment with oral antibiotics.

Extensive facial angiofibromas in tuberous sclerosis treated with carbon dioxide laserbrasion

Facial angiofibromas in systemic sclerosis cause significant cosmetic disfigurement and emotional distress. The treatment of these lesions have been a challenge because of the multiplicity of the lesions and the presence of the lesions at anatomically difficult sites. Four female patients between 12-22 years in age with extensive angiofibromas on face, nasolabial folds and chin for 2-10 years were treated with carbon dioxide (CO2) laser. The lesions in all patients were vaporized with the indigenously developed CO2 laser. All the patients were evaluated at 1 and 2 weeks and then every month for 6 months to assess the overall response to treatment and side effects. All the patients responded to the treatment and had an improvement of 50-80%. Transient erythema and hypopigmentation were seen in all the patients while post laser hyperpigmentation was seen in 2 patients. There were no other significant side effects. CO2 laser seems to be a good therapeutic tool for the treatment of extensive facial angiofibromas with good, cosmetically acceptable results even in dark (brown) skin patients with negligible side effects and minimal recurrences.

Psychiatric morbidity among patients attending cardiac opd

One hundred patients were selected from the cardiology outpatient department by non-probability purposive method. Each patient was evaluated by a psychiatrist and a consultant cardiologist The informations were recorded in a self designed proforma. The Hindi version of Goldberg's General Health Questionnaire and modified adjective check list for type A and type B personality characteristics were administered. Seventy five percent of the patients were having psychiatric problems. The cardiac patients were having psychiatric problems. The cardiac patients were having predominantly type A personality characteristics. Panic disorder was the predominant diagnosis in the psychiatric patients and depression was the main diagnosis in cardiac patients. These patients presented with complaints of chest pain, palpitation, ghabarahat, weakness, increased sweating, hot and cold flushes, choking, breathlessness, decreased appetite.etc.in cardiac OPD.

Azathioprine as a therapeutic modality for the treatment of severe adult atopic dermatitis

Atopic dermatitis is a difficult disease to treat. A few reports suggest that azathioprine may be effective in the treatment of atopic dermatitis. We therefore, evaluated the role of azathioprine in adult atopic dermatitis not adequately controlled with conventional therapy. Four patients of adult atopic dermatitis were treated with azathioprine 50 mg twice daily orally for 3-4 months. All the patients had complete remission after therapy. There were no significant side effects. Therefore, azathioprine can be considered a better and safer alternative drug in recalcitrant adult atopic dermatitis.

Skin and soft tissue infection

Abstract. Normal skin is heavily colonized by bacterial flora. The most common are the various nonpathogenic gram-positive bacteria such as Staphylococcus epidermidis (coagulase-negative). Skin and soft tissue infections are usually caused by Staphylococcus aureus (S. aureus) and Streptococcus pyogenes. This article discusses common and some not so common bacterial skin infections, including impetigo, folliculitis, furncles and carbuncles, cellulitis and erysipelas, gangrenous cellulitis, staphylococcal scalded skin syndrome and scarlet fever. Impetigo and ecthyma are common bacterial infections of the skin commonly caused by S. aureus and / or Group A streptoccus. In mild and localized impetigo topical antibiotics whereas in widespread or severe one and in ecthyma systemic antibiotics like, cloxacillin, erythromycin, azithromycin or cephalexin should be used. Folliculitis, furunculosis and carbuncle are folliculocentric infections caused by S. aureus involving the variable depth and extent of the follicle(s) and surrounding tissue. These conditions can be treated with topical or systemic antibiotics like cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid or vancomycin. Staphylococcal scalded skin syndrome is a toxin mediated exfoliative dermatosis caused by S. aureus of phase group II. Intravenous penicillinase-resistant anti-staphylococcal antibiotics like methicillin, cloxacillin, cephalosporin or erythromycin are required. Erysipelas and cellulitis are acute infections of dermal and subcutaneous tissues caused most frequently by Group A beta-hemolytic streptococci (erysipelas) or S. aureus requiring systemic antibiotics like oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vacomycin, minocycline or ciprofloxacin depending upon the severity, suspected causative organism and culture/sensitivity results. Gangrenous cellulitis is characterized by infection with necrosis of skin and underlying subcutaneous tissue due to various pathogens occurring at different site. Ampicillin, gentamicin, and either metronidazole or clindamycin intravenously in standard doses are recommended for the treatment.

Multiple lichen striatus--an unusual presentation

A 2-year-old mare child presented with multiple hypopigmented, flat topped papules with a bilateral distribution along the lines of Blaschko. A 7-year-old girl presented with multiple hypopigmented macules arranged linearly along the left upper and lower limb and also on the back along the lines of Blaschko. Three discrete lines in three distinct anatomical areas in a case of lichen striatus do not appear to have been described.

Cutaneous T-cell lymphoma treated with electron beam irradiation in Indian patients

BACKGROUND

Cutaneous T-cell lymphoma (CTCL) is a rare occurrence in India. Total skin electron irradiation (TSEI) is a well-accepted therapeutic modality for the treatment of CTCL throughout the world. The aim of this study was to retrospectively analyze the treatment outcome of TSEI in Indian patients with CTCL and to determine the different parameters affecting the disease-free survival in these patients.

METHODS

Fourteen male patients between 27 and 82 years of age with CTCL (duration of disease, 4 months to 2 years) were treated with TSEI between 1985 and 1998. Seven patients had early stage disease, while the other seven had advanced disease. Two patients had lymph node involvement at the time of presentation. The TSEI was performed according to the Stanford technique delivering a total dose in the range 8-36 Gy.

RESULTS

Of the 14 patients, 10 showed complete remission following TSEI. The total follow-up period was 4-110 months (median, 52 months). Five patients were disease free at the end of 5 years. Two patients died due to rapid progression of the disease, while the cutaneous lesions relapsed in three patients after 2-27 months and one patient developed visceral metastasis.

CONCLUSIONS

TSEI was an effective therapeutic modality for the treatment of CTCL in this group of patients, both as a curative and palliative measure, although the long-term prognosis is poor.

Infantile periocular haemangioma treated with two days in a week betamethasone oral mini pulse therapy

A one-month-old male infant had a large asymptomatic, bright red swelling on the face with inability to open his right eye since birth. On cutaneous examination there was a large brightly erythematous, lobulated, soft plaque on the right side of the forehead of 12 cm x 10 cm, involving the right upper eyelid obscuring the visual axis and extending on to the right upper lip. Ocular examination revealed normal anterior and posterior segments. Computed tomography of head and orbit confirmed the diagnosis of capillary haemangioma. The child was treated with oral betamethasone 2 mg as the signal daily dose on the two consecutive days in a week. After six weeks there was 80% reduction in the size of the lesion and the right upper eyelid almost completely cleared the visual axis. In another six weeks, the improvement was more than 90%.

Calf compartment syndrome and lumbar plexopathy following topical bovine thrombin-induced coagulopathy

We describe a patient with acquired thrombin inhibitor who developed tibial and peroneal neuropathies followed by lumbar plexopathy as a result of large calf and psoas muscle hematomas. Thrombin time, Prothombin time, and partial thromboplastin time were prolonged after repeated exposures to topical bovine thrombin in two orthopedic procedures Specific coagulation tests revealed that the coagulopathy was the result of an inhibitor to bovine thrombin that cross-reacted with human thrombin. We emphasize the risk of spontaneous hematomas that can compromise peripheral nerves as a result of an acquired coagulopathy following bovine thrombin exposure.

"Gilahari (lizard) syndrome" is it a new culture bound syndrome? - a case report

Culture bound syndromes are generally limited to specific societies or cultural areas and are localized. Authors report a case which seems to be a new culture bound syndrome, has atypical presentation and difficult to categories but could be diagnosed as somatoform NOS (F-45.9). This syndrome is commonly called Gilahari (Lizard) among local public and considered to be very serious and fatal illness prevalent in areas of west Rajasthan. According to public a small swelling climbs from the back reaches to neck leading to obstruction of airways and followed by death, though after examination and investigation patient did not revealed any physical illness so is seems to be a new culture bound syndrome.

Primary cutaneous amyloidosis involving the external ears along with the classical sites

A 26-year-old woman had multiple itchy persistent gradually progressive papular lesions on the forearms and shins for 10 and 4 years respectively. She also noticed similar lesions on both the ears for 4 years. There were no systemic symptoms. Cutaneous examination revealed multiple 2-3 mm discrete firm hyperpigmented papules on the extensors of forearms, shins and earlobes. Skin biopsy from all sites demonstrated deposits of amyloid in the papillary dermis. The patient was treated with cyclophosphamide 50 mg daily orally. There was more than 50% improvement in her lesions.

A two-step schedule for the treatment of actinomycotic mycetomas

Actinomycotic mycetomas usually respond slowly to treatment with antibiotics. In an attempt to hasten clinical resolution, we used a 2-step regimen consisting of an intensive phase of therapy with penicillin, gentamycin and co-trimoxazole for 5-7 weeks, followed by maintenance therapy with amoxicillin and co-trimoxazole. Seven patients were treated, all of whom showed significant reduction in discharge and swelling after the intensive phase. Maintenance therapy was continued for 2-5 months after the lesions became completely inactive. Five patients completed maintenance therapy, which was given for 6-16 months (mean 10.7 months), and remained free of disease during a mean post-treatment follow-up period of 6.4 months. The other 2 patients also responded satisfactorily and continue to receive maintenance therapy. Side-effects necessitating a modification of the treatment schedule occurred in 2 patients but reversed on discontinuation of the drugs responsible. This treatment schedule produces a rapid clinical response during the initial, intensive phase and promotes compliance with the longer maintenance phase of treatment necessary to achieve a complete cure.

Is hysteria still prevailing? A retrospective study of sociodemographic and clinical characteristics

A retrospective study was conducted in a psychiatric setup of S.P. Medical College, Bikaner (Raj.) to assess the social demographic and clinical characteristics of hysterical patients. The illness was more common in female patients. Most of the patients were young, married and illiterate. Nearly half of them had faced some stress prior to onset of their illness. Fits of unconsciousness and aphonia were the commonest presentation in female and male patients respectively. Duration of stay was 2-3 days and most of the patient responded well to different treatment modalities.

Failure of pentoxifylline to affect air- borne contact dermatitis caused by parthenium

Twelve patients, 9 males and 3 females between 22 to 65 years in age having air-borne contact dermatitis (ABCD) for 6 months to 12 years were included in this study. The diagnosis in each patient was confirmed by patch tests. Six of these patients (group I) were treated with pentoxifylline 400 mg three times a day orally in addition to topical clobetasol propionate and oral betamethasone 1.0 to 2.0 mg per day for 5 to 10 weeks. The other 6 patients (group II) were given the same treatment for the same duration but without pentoxifylline. The response to the treatment in both the groups was almost the same. The patients treated with pentoxifylline did not have any added benefit. There were no significant side effects of the therapy in either of the groups.

Determination of iodide by derivatization to 4-iodo-N,N-dimethylaniline and gas chromatography-mass spectrometry

A real-time determination of iodide is proposed which involves the oxidation of iodide with 2-iodosobenzoate in the presence of N,N-dimethylaniline. The reaction is completed within 1 min to yield 4-iodo-N,N-dimethylaniline, which is extracted in cyclohexane and determined by GC-MS. It was also possible to determine iodine by derivatization in the absence of 2-iodosobenzoate, and iodate by its reduction with ascorbic acid to iodide and subsequent derivatization. A rectilinear calibration graph was obtained for 0.02-50 micrograms l-1 iodide with a correlation coefficient of 0.9998. The limit of detection was 8 ng l-1 iodide. The method was applied to the determination of iodate in iodized table salt and free iodide and total iodine in sea-water, and to spiked samples when the recovery was in the range 96.8-104.3% (RSD 1.9-3.6%). A sample clean-up by solid-phase extraction with a LiChrolut EN cartridge is proposed.