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  Citation statistics : Table of Contents
   2007| July-August  | Volume 73 | Issue 4  
 
 
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CASE REPORTS
Type I lepra reaction presenting as immune reconstitution inflammatory syndrome
Vidya Kharkar, Urmila H Bhor, Sunanda Mahajan, Uday Khopkar
July-August 2007, 73(4):253-256
DOI:10.4103/0378-6323.33637  PMID:17675735
Immune reconstitution inflammatory syndrome (IRIS) is an unusual inflammatory reaction due to infectious and non-infectious causes occurring in human Immunodeficiency virus (HIV)-infected patients. IRIS occurs after the initiation of antiretroviral therapy. There are no reports of type I lepra reaction due to IRIS in published literature from India. We report two cases of HIV-infected males who presented with borderline tuberculoid leprosy in type 1 reaction after the initiation of highly active antiretroviral treatment (HAART). Case 1 presented with multiple, tender, erythematous and hypoesthetic plaques on the trunk and extremities after 3 months of antiretroviral therapy. In case 2, type I lepra reaction was observed 2 months after the initiation of HAART.
  32 7,814 659
ORIGINAL ARTICLE
Effect of oral granisetron in uremic pruritus
Pouran Layegh, Mohammad Javad Mojahedi, Parisa Emamgholi Tabar Malekshah, Fakhrozaman Pezeshkpour, Mohamad Vahedian, Fatemeh Nazemian, Farzaneh Sharifi Pour
July-August 2007, 73(4):231-234
DOI:10.4103/0378-6323.32887  PMID:17675729
Background : Renal itch is a relatively common and distressing problem for patients with chronic renal failure. Granisetron, is a potent and selective inhibitor of 5-HT3 receptors. There have been some studies about the effect of ondansetron in uremic pruritus and one case report has recently described relief of renal itch with granisetron. Aims : To evaluate the effect of Granisetron on uremic pruritus in Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients. Methods: To study the prevalence of uremic pruritus, patients on CAPD and HD were asked to complete a pruritus questionnaire.Their replies were scored based on numerical scales. Pruritus was graded, according to the total points for each patient, as mild, moderate or severe. Fourteen patients with moderate to severe pruritus were enrolled in the trial. During treatment, patients received granisetron (1 mg tablet twice a day P.O), for a period of 1 month. They were asked to score the severity of pruritus twice a day. Results : Seventy seven percent of the patients responded to the treatment and at 1 st , 2 nd and 4 th week the mean values of the pruritus scores were 23, 16 and 8 points respectively. Before starting treatment the score was 31 points ( P =0.03). Weekly clinical and laboratory examination showed no important side effects. Conclusion : Granisetron might be an effective, safe and well tolerated drug for the treatment of uremic pruritus.
  17 7,988 599
A modified two-step treatment for actinomycetoma
M Ramam, Radhakrishna Bhat, Taru Garg, Vinod K Sharma, R Ray, MK Singh, U Banerjee, C Rajendran
July-August 2007, 73(4):235-239
DOI:10.4103/0378-6323.32888  PMID:17675730
Background: Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication. Methods: Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months. Results: Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 ± 1.7 months. Maintenance treatment was continued for a mean of 9.1 ± 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 ± 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole. Conclusion: This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.
  17 17,733 1,225
What is the appropriate duration of a therapeutic trial in cutaneous tuberculosis? Further observations
M Ramam, Trilokraj Tejasvi, Yashpal Manchanda, Sandeep Sharma, Rashmi Mittal
July-August 2007, 73(4):243-246
DOI:10.4103/0378-6323.32890  PMID:17675732
Background: Laboratory tests for the diagnosis of cutaneous tuberculosis lack adequate sensitivity and specificity and a trial of therapy is often used as a diagnostic test in difficult cases. However, the duration for which the trial should be undertaken is not clearly defined. Our previous study indicated that one month of therapy was adequate to detect a clinical response to treatment. However, about half the patients first reported after one month of treatment, some much later. Method: We therefore analysed the treatment records of 107 patients who received four-drug, short course, antitubercular therapy for a diagnosis of cutaneous tuberculosis in our hospital and who were asked to return for follow-up at biweekly intervals in the first month of treatment. Result: Twenty-one patients did not return for any follow-up visit, nine patients did not respond to treatment and treatment was stopped in one patient. Of the remaining 76 patients, 72 patients were recorded to have distinct clinical improvement within five weeks of starting treatment while only four patients showed improvement after 60-123 (8-17 weeks) days of therapy. Conclusion: These findings indicate that five weeks appears to be an adequate duration of a therapeutic trial in patients suspected to have cutaneous tuberculosis, with the exception of tuberculids and patients showing minimal clinical activity before treatment. Patients who have not responded by this time are unlikely to do so with further treatment and should have their diagnosis reviewed.
  16 6,752 581
REVIEW ARTICLES
An approach to the diagnosis of neutrophilic dermatoses: A histopathological perspective
KC Nischal, Uday Khopkar
July-August 2007, 73(4):222-230
DOI:10.4103/0378-6323.33634  PMID:17675728
Neutrophilic dermatoses comprises of non-infective dermatoses which are histopathologically characterized by neutrophil predominant infiltrate and clinically, respond promptly to corticsteroids. Conditions primarily with vasculitis though neutrophilic are excluded from this group. In this article we intend to briefly outline the approach to diagnose these conditions with histological perspective. The ambiguity regarding few recent dermatosis viz., rheumatoid neutrophilic dermatosis, bowel associated-dermatosis-arthritis syndrome etc. with regard to their inclusion in this group has also been highlighted.
  16 39,539 2,049
SPECIALTY INTERFACE
Minimizing side effects of systemic corticosteroids in children
CT Deshmukh
July-August 2007, 73(4):218-221
DOI:10.4103/0378-6323.33633  PMID:17675727
Corticosteroids are potent drugs used in management of various inflammatory and autoimmune disorders. The antiinflammatory effects of corticosteroids cannot however be separated from their metabolic effects. Children are more vulnerable to their side effects, particularly the effects on growth, immunity and adrenal suppression. It is essential for the treating physician to be aware of the side effects and the measures to be taken to minimize them. A side effect that is unique to children is growth suppression, which is helped by alternate day treatment. Administration of small doses of prednisolone (10-15 mg/day or < 0.5 mg/kg/day single dose) on alternate days, does not slow growth velocity significantly. The potency of dexamethasone and betamethasone in suppressing growth is nearly 18 times higher than that of prednisolone. There is some evidence that the administration of growth hormone can reverse these changes.
  15 52,064 1,393
FOCUS
Microdermabrasion
Preeti Savardekar
July-August 2007, 73(4):277-279
DOI:10.4103/0378-6323.33650  PMID:17675747
  12 14,752 1,112
BRIEF REPORT
Fine needle aspiration cytology in reactional and non-reactional leprosy
PK Nigam, Prashant Kumar, N Pathak, S Mittal
July-August 2007, 73(4):247-249
DOI:10.4103/0378-6323.33635  PMID:17675733
Background: Histopathological evaluation of skin lesions is not feasible in many leprosy endemic areas. Fine needle aspiration cytology (FNAC) is a simpler tool compared to histopathology for the evaluation of the cytomorphology of skin lesions. Aims: To study the cytomorphology of leprosy lesions in fine needle aspirates and correlate it with the histopathology. Methods: Seventy leprosy patients diagnosed and classified according to Ridley Jopling scale were included. Fine needle aspirates were taken from the lesion followed by a skin biopsy from the same site for histopathological examination after H/E staining. Results: Borderline leprosy patients with Type I reaction showed significantly large numbers of giant cells, collagen and elastin in their smears as compared to those without reaction. The smears were more heavily cellular with fragmented collagen and elastin along with significant increase in neutrophils in patients with Type II reaction while foamy macrophages with fatty background were common in non-reactional lepromatous leprosy patients. A complete correlation between histopathological and cytomorphological findings was observed in 77.3% of cases. Conclusion: FNAC may be used as an alternative tool to assess leprosy lesions in areas where histopathological services are not readily available.
  7 6,073 450
CASE REPORTS
Cutaneous neonatal lupus erythematosus with unusual features
Shankar Sawant, ST Amladi, SL Wadhawa, CS Nayak, BP Nikam
July-August 2007, 73(4):250-252
DOI:10.4103/0378-6323.33636  PMID:17675734
A three month-old boy was brought by his mother with complaints of multiple reddish lesions on his trunk and face since birth. The patient had erythematous annular plaques with scaling on his extremities, palms and soles with periorbital erythema and edema giving the characteristic "eye mask" or "owl's eye" appearance. His mother did not have history of any illness. Hemogram, liver and renal function tests were within normal limits. A skin biopsy was suggestive of subacute cutaneous lupus erythematosus. Immunological work-up was positive for antinuclear antibodies (ANA) (1:40) with anti-Ro titers of 3.4 and 3.47 (>1.1 = clinically significant titre) in the mother and child respectively, although negative for anti-La antibodies. The child's electrocardiogram and 2D echocardiography were normal. We are presenting a case of anti-Ro-positive cutaneous lupus erythematosus with an uncommon skin manifestation.
  6 5,070 419
Intertriginous bullous morphea: A clue for the pathogenesis?
Mukaddes Kavala, Ilkin Zindanci, Cuyan Demirkesen, Emek Kocaturk Seyhan Beyhan, Zafer Turkoglu
July-August 2007, 73(4):262-264
DOI:10.4103/0378-6323.33640  PMID:17675738
Bullae occurring in lesions of morphea are uncommon. The cause of bullae formation in morphea is multifactorial, although lymphatic obstruction from the sclerodermatous process is considered the likeliest cause. Bullous morphea may be confused clinically with lichen sclerosus et atrophicus since both diseases may cause bullae in sclerodermatous plaques. A 69-year-old woman presented with a history of generalized morphea diagnosed 9 years earlier; and a 1-month history of pruritic bullae on her inframammary folds, axillary regions, lower abdomen, upper extremities and inguinal folds. Physical examination revealed multiple erythematous erosions, hemorrhagic vesicles and eroded bullae with slight scale or crusts overlying hypopigmented, indurated, shiny plaques. Skin biopsy revealed prominent edema in the papillary dermis, resulting in bulla formation and thickening of collagen fibers within the dermis. Direct immunofluorescence was negative. According to histologic and clinical features, the diagnosis of bullous morphea was established.
  5 6,119 341
NET STUDY
Comparative efficacy of intralesional sodium stibogluconate (SSG) alone and its combination with intramuscular SSG to treat localized cutaneous leishmaniasis: Results of a pilot study
Ajeet K Negi, Nand Lal Sharma, Vikram K Mahajan, Nitin Ranjan, Anil K Kanga
July-August 2007, 73(4):280-280
DOI:10.4103/0378-6323.33651  
Background: Intralesional sodium stibogluconate (SSG) has become first line therapy for localized cutaneous leishmaniasis (LCL). Aims: This study compares the efficacy of intralesional SSG given alone with that of intralesional SSG combined with intramuscular SSG. Methods: Thirty-two patients aged between 5-56 years were included in the study. The first group received three injections of intralesional SSG on alternate days while the other group received three injections of intralesional SSG similar to the first group and the rest of the calculated dose as a simultaneous, intramuscular injection. Patients were followed up every four weeks to assess for cure/ the need for repeating the treatment. Results: Five patients from group 1 having small nodular lesions of < six months duration were cured after 1-2 treatment cycles. However, six patients with mucosal lesions, large lesions and lesions of > six months duration needed 3-5 treatment schedules. Most plaques and mucosal lesions in seven patients in group 2 cleared with two treatment cycles. Conclusion: Intralesional combined with intramuscular SSG appears more effective in LCL and gave qualitatively superior healing than intralesional SSG given alone
  4 4,819 334
EDITORIAL
Etiopathogenesis of pruritus due to systemic causes: Implications for treatment
Uday Khopkar, Sushil Pande
July-August 2007, 73(4):215-217
DOI:10.4103/0378-6323.33632  PMID:17675726
  3 10,812 999
LETTER TO EDITOR
Type I hypersensitivity to Parthenium hysterophorus in patients with parthenium dermatitis
Kaushal K Verma
July-August 2007, 73(4):265-265
DOI:10.4103/0378-6323.33641  PMID:17675739
  3 3,367 282
Cutaneous larva migrans of the genitalia
Raghavendra Rao, Smitha Prabhu, H Sripathi
July-August 2007, 73(4):270-271
DOI:10.4103/0378-6323.33647  PMID:17675743
  3 5,009 328
ORIGINAL ARTICLE
Detection of pemphigus autoantibodies in healthy relatives of Turkish patients with pemphigus
Mukaddes Kavala, Ozgur Emek Kocaturk, Cuyan Demirkesen, Burce Can, Ilkin Zindanci, Zafer Turkoglu
July-August 2007, 73(4):240-242
DOI:10.4103/0378-6323.32889  PMID:17675731
Background: Pemphigus autoantibodies have been reported in healthy relatives of pemphigus patients suggesting a genetic predisposition in the pathogenesis of the disease. Aims: To test for the presence of pemphigus autoantibodies in healthy relatives of Turkish patients of pemphigus. Methods: The study group comprised 45 pemphigus patients, 75 unaffected family members and 47 healthy individuals in the control group. Direct and indirect immunofluorescence techniques were performed to determine the presence of pemphigus autoantibodies. Results: By indirect immunofluorescence staining, circulating pemphigus autoantibodies were found in 26.7% of the relatives and in only two of the controls ( P value = 0.0001). A direct immunofluorescence technique revealed positive results in three (4%) of the relatives and none of the controls. Conclusion: The presence of pemphigus autoantibodies in clinically healthy relatives indicates that genetic predisposition is necessary but not sufficient for the development of clinical disease.
  3 4,660 341
CASE REPORTS
Familial Behcet's disease
Neeraj Srivastava, Satish Chand, Manish Bansal, Kanchan Srivastava, Sanjay Singh
July-August 2007, 73(4):260-261
DOI:10.4103/0378-6323.33639  PMID:17675737
There are very few reports of Behηet's disease from India. Familial aggregation of Behηet's disease has been reported with restricted geographical distribution. We report here familial Behcet's disease from India in two brothers aged 30 and 32 years. Both patients had recurrent oral and genital ulcers for approximately five years. They also had arthralgias on and off along with fever. Pathergy test was positive in both cases. Their younger brother and a sister had recurrent oral aphthous ulcers.
  2 4,951 461
Moore Federman syndrome: A rare cause of pseudoscleroderma
K Muhammed, G Nandakumar
July-August 2007, 73(4):257-259
DOI:10.4103/0378-6323.33638  PMID:17675736
The Moore Federman syndrome (MFS) is characterized by short stature, stiffness of the joints, characteristic facies and ocular abnormalities. Herein, we report the case of a 45 year-old lady with short stature, thickening of the skin, stiffness of the joints, typical facies, iridodonesis and cataract since the age of 12 years. She had short digits and no family history of similar illness. To the best of our knowledge, this could be the fourth report of MFS.
  1 7,189 318
LETTER TO EDITOR
Acute lymphocytic leukemia in sporadic neurofibromatosis
Pratik Gahalaut, Mir Mubashir Ali
July-August 2007, 73(4):267-268
DOI:10.4103/0378-6323.33644  PMID:17675741
  1 5,773 277
Pyoderma gangrenosum in a two year-old child
Ramesh Sharma, Milind A Borkar, Manjiri A Oke, Anne R Wilkinson, Sabiha A Maimoon
July-August 2007, 73(4):268-270
DOI:10.4103/0378-6323.33645  PMID:17675742
  1 4,093 342
QUIZ
Infiltrated plaques on the face and back
Marcia Ferreira, Marta Teixeira, Madalena Sanches, Manuela Selores
July-August 2007, 73(4):283-284
DOI:10.4103/0378-6323.33656  PMID:17675748
  1 4,468 307
RESIDENT’S PAGE
Formulation of a research project
Gurmohan Singh, Vineet Kaur
July-August 2007, 73(4):273-276
DOI:10.4103/0378-6323.33649  PMID:17675746
  1 6,497 540
BOOK REVIEW
Handbook of dermatological drug therapy
KK Raja Babu
July-August 2007, 73(4):282-282
  - 4,375 302
LETTER TO EDITOR
Comedone-like changes overlying neurofibromas
Chandrashekar Laxmisha, Devinder Mohan Thappa
July-August 2007, 73(4):271-272
DOI:10.4103/0378-6323.33648  PMID:17675745
  - 2,930 247
A possible role for human follicle mites in skin's defense against bacteria
MR Namazi
July-August 2007, 73(4):270-270
DOI:10.4103/0378-6323.33646  PMID:17675744
  - 5,784 231
Authors' reply
Chembolli Lakshmi, CR Srinivas
July-August 2007, 73(4):265-266
DOI:10.4103/0378-6323.33642  
  - 2,014 195
Leprosy detection: Involvement of teachers
Mudera P Cariappa
July-August 2007, 73(4):266-267
DOI:10.4103/0378-6323.33643  PMID:17675740
  - 2,919 287
NET LETTER
Cutaneous complications of pentazocine abuse
Saurabh Agarwal, Manoj Trivedi
July-August 2007, 73(4):280-280
DOI:10.4103/0378-6323.33653  
  - 3,153 257
NET QUIZ
Verrucous lesion on dorsum of the foot
Shyam B Verma
July-August 2007, 73(4):281-281
DOI:10.4103/0378-6323.33654  
  - 5,207 299
NET STUDY
Epidermolytic hyperkeratosis with a rare digital contracture
Sudip Das, Alok Kumar Roy, Chinmoy Kar, Arunasis Maiti
July-August 2007, 73(4):280-280
DOI:10.4103/0378-6323.33652  
A sixteen year-old male patient with no history of consanguinity in the family, reported with patchy, thickened lichenified plaques over the whole body. Some areas had normal skin while some were Blaschkoid lesions. The child had delayed milestones along with hypogonadism. Digital contracture with palmoplantar keratoderma was present. Histopathology showed characteristic vacuolar degeneration of the upper epidermis and suprabasilar keratinocytes with hyperkeratosis.
  - 3,396 214
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