Search

Background: The diagnosis of ventilator-associated pneumonia (VAP) remains a challenge, with clinicians mainly relying on clinical, radiological, and bacteriologic strategies to manage patients with VAP. Aims: To compare the results of non-bronchoscopic and bronchoscopic techniques of distal airway sampling for the diagnosis of VAP. Settings and Design: This was a single-center prospective diagnostic accuracy study done in the 14-bedded intensive care unit of a tertiary care referral hospital. Materials and Methods: Patients aged ≥18 years, on mechanical ventilation for ≥48 h, and with clinical suspicion of VAP (fever, leukocytosis, and increased tracheal secretions) either on admission or during their stay were included. Every patient underwent both procedures for sample collection, first non-bronchoscopic protected bronchoalveolar lavage (NP-BAL) and then bronchoscopic BAL (B-BAL). Clinical Pulmonary Infection Score (CPIS) was calculated for each patient and the collected samples were evaluated in laboratory using standard microbiological techniques. Statistical Analysis Used: The sensitivity, specificity, positive predictive value, and negative predictive value of NP-BAL and B-BAL for the diagnosis of VAP were calculated taking CPIS score of >6 as index test for the diagnosis of VAP. Results: Sixty patients were included in the study. Both NP-BAL and B-BAL had concordance with the CPIS at 69.1%. The concordance between NP-BAL and B-BAL was better at 67.6% with a kappa coefficient of 0.064 (P = −0.593). The yield and sensitivity of NP-BAL were comparable to that of B-BAL. Conclusions: The blind NP-BAL is an equally effective method of airway sampling and could be a better alternative to replace more invasive B-BAL for microbiologic diagnosis of VAP. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is characterized by multiple hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation. Here we present, a case of multiple gastrointestinal hamartomatous polyps in a 22-year-old male who had been operated for intestinal obstruction due to ileocolic intussusception. Resection of the affected segment was done with proximal ileostomy and distal mucous fistula formation. Clinicopathological diagnosis of PJS was made. Later, during ileostomy closure, it was found that the patient had a transverse colonic mass which was resected. Histological examination with immunohistochemistry confirmed it to be a Mucosa-Associated Lymphoid Tissue Lymphoma (MALToma). Colonic MALToma in the background of PJS is a unique case for which it has been reported. [ABSTRACT FROM AUTHOR]

Keratoacanthoma (KA) is a rapidly evolving benign cutaneous tumor, occurring in elderly individuals with a tendency towards spontaneous regression and histopathologic similarity to squamous cell carcinoma. Tumoral calcinosis is an uncommon condition, associated with the deposition of painless calcific masses. The occurrence of these two conditions in the same patient is a rarity itself, whereas deposition of calcium within the KA lesion in our 13-year-old patient makes it even more intriguing. Such an association has been seldom reported in the literature, and this prompted the current report. [ABSTRACT FROM AUTHOR]

Kindler's syndrome (KS) is a rare inherited skin disease characterized by acral blistering, photosensitivity, progressive poikiloderma, and cutaneous atrophy along with different types of mucosal involvement. We hereby report KS in two siblings. The case is being reported for its rarity and for emphasizing the importance of considering this condition in the differential diagnosis of disorders that may cause blistering, cutaneous atrophy, and/or poikilodermatous skin changes. Besides, the presentation of the disease in two of the members of the same family makes the case even more interesting. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on the necrolytic acral erythema (NAE), skin disease, patient, without Hepatitis C virus infection.

An 18‑year‑old girl presented with multiple itchy hyperpigmented papules and plaques, along with tense blisters over the lower limbs and buttocks for last 3 months. These papules, plaques, and bullae were mostly localized to preexisting scars. The histopathological findings from papule and bulla were consistent with lichen planus (LP) and bullous pemphigoid, respectively. Direct immunofluorescence (DIF) of perilesional skin around bulla showed linear deposition of IgG and C3. Considering clinical, histopathological and DIF findings, diagnosis of LP pemphigoides (LPP) was made. The preferential localization of LPP lesions over preexisting scars was a very interesting finding in our case an extremely rare instance of the isotopic phenomenon. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35‑year‑old female suffering from herpes zoster and consulted for rash. Topics discussed include distribution of erythematous scaly papules coalescing to form plaques over the left T8–T10 dermatomes, initiation of the immunological cascade of the pathogenesis of the second disease from neuropeptides, and elevation of TNF‑alpha in psoriatic skin lesions as the factor for the development of psoriasis over the healed sites.

A case study of a 32‑year‑old man suffering from occasional breathlessness is presented, who is admitted for the evaluation of treatment resistant popular, and cystic lesions. It mentions diagnostic test of the patient revealed pulmonary sarcoidosis. It mentions patients was later diagnosed with multiple eccrine hydrocystoma. It discusses the use of atropine, and botulinum toxin Type A, as a treatment procedure.

The article presents a letter report on the topic of poroid hidradenoma, a type of asymptomatic solitary swelling. It also presents a case study of a 36-year-old healthy male who was presented with a solitary mass on his left forearm present from the past three years. The patient is examined and was revealed with a solitary firm nodule. He was performed with excision biopsy that represented dermal neoplasm in the form of a tumor.

A case study is presented of a 59‑year‑old man presented with an asymptomatic solitary scaly elevated lesion near the nose. It informs that the patient was diagnosed with cutaneous B‑cell lymphoma (CBCL), a rare group of lymphoproliferative disorders of the skin. It mentions that he was offered intralesional rituximab as a therapeutic option.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is apparently benign, locally proliferating lesion composed of vascular channels with surrounding infiltrate of lymphocytes and eosinophils. We report two cases with long‑standing papulonodular lesions on the left ear who presented to us on account of trauma‑induced bleeding and cosmetic issues. Peripheral blood eosinophilia was present, and histological findings were consistent with a diagnosis of ALHE. The rarity of this disease in the pediatric age group prompted the present report. [ABSTRACT FROM AUTHOR]

A quiz concerning the sudden appearance of numerous small nonpruritic eruptions or generalized papules all over the body of a pubertal female is presented.

The article presents a case study about a 60-year-old man presented with a solitary, nonhealing fragile mass over the abdomen and have been diagnosed with a basal cell carcinoma, the most common malignancy of skin worldwide.

The article presents a case study about a 10-month-old female infant with an amniotic band syndrome or a congenital depressed scar over her face and scalp leading to facial asymmetry.

A letter to the editor is presented regarding the case study of a 21-year-old female who was diagnosed with Angioma serpiginosum after the complaints of a patchy and blaschkoid pattern in the left breast and left upper extremity.

A letter to the editor is presented regarding the case of fixed drug eruption (FDE) in a 30-year-old man with a history of eryhtematous patches, buccal mucosa, and necrotic keratinocytes.

Granular cell tumor is a distinctly rare neoplasm of neural sheath origin. It mainly presents as a solitary asymptomatic swelling in the oral cavity, skin, and rarely internal organs in the middle age. Histopathology is characteristic, showing polyhedral cells containing numerous fine eosinophilic granules with indistinct cell margins. We present a case of granular cell tumor on the back of a 48-year-old woman which was painful, mimicking an adnexal tumor. [ABSTRACT FROM AUTHOR]

Palmo-plantar keratodermas (PPKD) are a diverse group of acquired and hereditary disorders, characterized by excessive thickening of the skin of palms and soles. Here, we report a case of Type I or Buschke-Fischer-Brauer variant of punctate palmo-plantar keratoderma, in a 66-year-old gentleman. The association of our case with Hodgkin's lymphoma along with linear configuration of lesions on the palms evoked the current report. [ABSTRACT FROM AUTHOR]

The article presents the case of a 40-year-old lady with a painful ulcerated plaque over the sole of the right foot. Topics discussed include differential diagnoses considered including Bowen's disease, lupus vulgaris, and atypical mycobacterial infection, the treatment of oral prednisolone given to the patient, and characteristics of ulcerative or erosive lichen planus (LP).

The article presents the case study of a 65‑year‑old healthy male who was presented with asymptomatic growth on his right thigh, also includes an answer to the question of nodular hidradenoma diagnosis.

A letter to the editor is presented regarding idiopathic acquired true leukonychia totalis in a 14-year-old otherwise healthy boy presented with whitening of the finger nails.

The article presents a case study of a 7-year-old girl presented to the out-patient department (OPD), with discoloration of her right index finger nail, along with its separation at the proximal. It states that the dermatological examination of the finger revealed the separation of its nail plate from the nail bed. It mentions that the diagnosis of onychomadesis was made, and her parents were counselled regarding the benign nature of the disease.

The article presents the case of a 50-year-old woman who complains of blackish discoloration of her fingernails and toenails to discuss the drug imatinib-induced transverse melanonychia disease. The woman is suffering from chronic myelogenous leukemia (CML) and is taking imatinib as treatment. Also cited are the two patterns of melanoychia, namely, longitudinal melanonychia and transverse melanonychia, as well as the common etiologies of longitudinal melanonychia, including Addison's disease.

A quiz about the condition of a patient with multiple papules on the shaft of the penis is presented.

Nevus lipomatosus cutaneous superficialis (NLCS) is a benign dermatosis, histologically characterized by the presence of mature ectopic adipocytes in the dermis. We hereby report a case of a 10-year-old boy who presented with multiple huge swellings on the scapular regions and lower back. The lesions were surmounted by small papules, along with peau-d orange appearance at places. Histology showed features consistent with NLCS. The case is being reported for the unusual clinical presentation. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 35-year-old lady with the complaints of increased sweating on right side of her face and upper trunk and was diagnosed of Ross syndrome. Topics covered include the medical history of the patient, characteristics of Rose syndrome, and how demonstration of anhidrosis can be done.

The article presents a case of porokeratotic eccrine ostial and dermal duct nevus (PEODDN), a rare disorder of keratinization, with unique clinical and histopathological findings. Topics discussed include the characteristics of PEODDN, diseases reportedly associated with PEODDN, and the limited treatment options for PEODDN.

The article presents a quiz about the case of a 16-year-old boy with papulo-nodules and plaques of varied sizes on the axilla, neck and ear.

A response from the author of the article "Pachyonychia congenita type 1: Case report and review of the literature" that was presented in a 2016 issue is presented.