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Background: Chronic urticaria patients who demonstrate autoantibodies against the high-affinity receptor of IgE (FceRI) or IgE itself tend to have a high itch and wheal score, and systemic symptoms may have a significant bearing on their management in terms of super pharmacologic doses of antihistamines needed or use of immunomodulators. Most studies have used histamine release assays rather than autologous serum skin tests (ASSTs) for correlating urticaria severity and histamine releasing activity. Methods: An ASST was performed in 100 (M:F, 31:69) chronic urticaria patients aged between 14 and 63 (mean, 32.69 ± 13) years with an objective to study the clinicoepidemiologic features like age, sex, age of onset and duration, frequency and distribution of wheals, urticaria severity, angioedema and systemic manifestations in ASST-positive and ASST-negative patients. Results: ASST was positive in 46% of the patients and negative in 54% of the patients, respectively. Both groups showed no statistically significant difference for epidemiological details. However, the ASST-positive patients had a higher mean urticaria activity score, frequent involvement of more body sites, particularly palms and soles, presence of throat angioedema and general constitutional, respiratory or gastrointestinal symptoms in comparison with the ASST-negative patients. Conclusions: Apparently, ASST-positive patients have more severe clinical manifestations of chronic urticaria. The knowledge will be useful for the treating dermatologists and patients alike in view of its therapeutic implications. [ABSTRACT FROM AUTHOR]

Background: There is a strong need to develop a photopatch test tray suitable for Indian patients of photodermatitis as European/Scandinavian photopatch test trays may not be wholly relevant for them. Aim: We carried out this study using photoallergens relevant in the Indian context to determine their relevance in patients of photodermatitis. Methods: Thirty patients (M:F, 23:7) between 19 and 76 years of age of photodermatitis and 10 controls were patch- and photopatch tested with 20 common photoallergens. In addition, the patients were also (photo) patch tested with articles of daily use as and when these were suspected to be the cause. Results: Forty-three positive reactions to one or more antigens were seen in 22 (74%) patients. Fourteen positive photopatch tests to seven allergens were observed in 10 (33%) patients, and nine (30%) of them had a definite relevance. The most common contact allergen was fragrance mix (FM) (30%), followed by p-phenylenediamine (20%) and Parthenium hysterophorous (17%). The definite relevance of the patch- and photopatch tests could be correlated in 47% of these patients. Conclusions: FM is the most common contact and photocontact allergen among the various photopatch test antigens. Although differences in technique and evaluation make direct comparison between different centers difficult, still photopatch testing remains an integral part and gold standard for the work-up of the photosensitive patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Elimination of allergens/topical medications causing contact dermatitis in venous eczema, which poses a significant problem in its chronicity and treatment, provides the basis for better therapeutic outcome. Our objective was to determine the pattern of contact sensitization in venous eczema patients in Himachal Pradesh (India).Methods: Thirty-four patients (M:F, 31:3) and 10 controls (M:F, 6:4) were patch tested with Indian standard series and 10 commonly used topical medicaments.Results: Positive patch test results were seen in 50% (M:F, 16:1) of the patients. Common allergens were Fragrance mix (15%), p-phenylendiamine (15%), nickel (9%), wool alcohol (9%), chinoform (9%), balsum of Peru (5%), cobalt chloride (5%), potassium dichromate (3%), epoxy resin (3%), thiuram mix (3%) and formaldehyde (3%). Only sisomycin and miconazole among the topical medications elicited a positive patch test reaction in 3 and 5% patients, respectively. Neomycin contact sensitivity was not seen in any of the patients. One patient who had exacerbation of venous eczema following accidental application of topical diclofenac showed a positive patch test reaction to it.Conclusions: Patch test should be used to identify the topical agents that may be responsible for perpetuation or aggravation of eczema, especially in patients who do not improve despite adequate treatment of other underlying cause(s). [ABSTRACT FROM AUTHOR]

A quiz about the case of a 10-year-old child who presented with photosensitivity and recurrent blistering on exposed areas is presented.

Extensive use of chromium (Cr) in anthropogenic activities leads to Cr toxicity in plants causing serious threat to the environment. Cr toxicity impairs plant growth, development, and metabolism. In the present study, we explored the effect of NaHS [a hydrogen sulfide; (H 2 S), donor] and silicon (Si), alone or in combination, on two chickpea ( Cicer arietinum ) varieties (Pusa 2085 and Pusa Green 112), in pot conditions under Cr stress. Cr stress increased accumulation of Cr reduction of the plasma membrane (PM) H + -ATPase activity and decreased in photosynthetic pigments, essential minerals, relative water contents (RWC), and enzymatic and non-enzymatic antioxidants in both the varieties. Exogenous application of NaHS and Si on plants exposed to Cr stress mitigated the effect of Cr and enhanced the physiological and biochemical parameters by reducing Cr accumulation and oxidative stress in roots and leaves. The interactive effects of NaHS and Si showed a highly significant and positive correlation with PM H + -ATPase activity, photosynthetic pigments, essential minerals, RWC, proline content, and enzymatic antioxidant activities (catalase, peroxidase, ascorbate peroxidase, dehydroascorbate reductase, superoxide dismutase, and monodehydroascorbate reductase). A similar trend was observed for non-enzymatic antioxidant activities (ascorbic acid, glutathione, oxidized glutathione, and dehydroascorbic acid level) in leaves while oxidative damage in roots and leaves showed a negative correlation. Exogenous application of NaHS + Si could enhance Cr stress tolerance in chickpea and field studies are warranted for assessing crop yield under Cr-affected area., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Singh, Singh, Siddiqui, Alamri, Sarkar, Rathore, Prasad, Singh, Sharma, Kalaji and Brysiewicz.)

Chromium (Cr) accumulation in crops reduces yield. Here, we grew two chickpea cultivars, Pusa 2085 (Cr-tolerant) and Pusa Green 112 (Cr-sensitive), in hydroponic and pot conditions under different Cr treatments: 0 and 120 µM Cr and 120 µM Cr + 100 mM glycine betaine (GB). For plants grown in the hydroponic media, we evaluated root morphological attributes and plasma membrane integrity via Evans blue uptake. We also estimated H + -ATPase activity in the roots and leaves of both cultivars. Plants in pots under conditions similar to those of the hydroponic setup were used to measure growth traits, oxidative stress, chlorophyll contents, enzymatic activities, proline levels, and nutrient elements at the seedling stage. Traits such as Cr uptake in different plant parts after 42 days and grain yield after 140 days of growth were also evaluated. In both cultivars, plant growth traits, chlorophyll contents, enzymatic activities, nutrient contents, and grain yield were significantly reduced under Cr stress, whereas oxidative stress and proline levels were increased compared to the control levels. Further, Cr uptake was remarkably decreased in the roots and leaves of Cr-tolerant than in Cr-sensitive cultivars. Application of GB led to improved root growth and morpho-physiological attributes and reduced oxidative stress along with reduced loss in plasma membrane integrity and subsequently increase in H + -ATPase activity. An increment in these parameters shows that the exogenous application of GB improves the Cr stress tolerance in chickpea plants., (© 2022. The Author(s).)

Chromium (Cr) presently used in various major industries and its residues possess a potent environmental threat. Contamination of soil and water resources due to Cr ions and its toxicity has adversely affected plant growth and crop productivity. Here, deleterious effects of different levels of Cr (VI) treatments i.e., 0, 30, 60, 90, and 120 μM on two mungbean cultivars, Pusa Vishal (PV) and Pusa Ratna (PR), in hydroponic and pot conditions were evaluated. Germination, seedling growth, biomass production, antioxidant enzyme, electrolytic leakage, oxidative stress (hydrogen peroxide and malondialdehyde), and proline content were determined to evaluate the performance of both cultivars under hydroponic conditions for 15 days. The hydroponic results were further compared with the growth and seed yield attributes of both the genotypes in pot experiments performed over 2 years. Seedling growth, biomass production, total chlorophyll (Chl), Chl- a , Chl- b , nitrogen content, plant height, seed protein, and seed yield decreased significantly under the 120 μM Cr stress level. Activities of antioxidant enzymes superoxide dismutase, catalase, ascorbate peroxidase and peroxidase increased in the leaves following Cr exposure at 60-90 μM but declined at 120 μM. Cr-induced reductions in growth and seed yield attributes were more in the sensitive than in the tolerant cultivar. Cr accumulation in the roots, stems, leaves, and seeds increased with an increase in Cr concentrations in the pot conditions. Furthermore, for both cultivars, there were significant negative correlations in morpho-physiological characteristics under high Cr concentrations. Overall results suggest that (PR) is more sensitive to Cr stress (PV) at the seedling stage and in pot conditions. Furthermore, (PV) can be utilized to study the mechanisms of Cr tolerance and in breeding programs to develop Cr-resistant varieties., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Singh, Sharma, Singh, Yerramilli, Narayan, Sarkar and Singh.)

The ever-increasing industrial activities over the decades have generated high toxic metal such as chromium (Cr) that hampers the crop productivity. This study evaluated the effect of Cr on two chickpea (Cicer arietinum L.) varieties, Pusa 2085 and Pusa Green 112, in hydroponic and pot-grown conditions. First, growth parameters (seed germination, seedling growth, and biomass production) and physio-biochemical parameters (oxidative stress and the content of antioxidants and proline) were measured to evaluate the performance of both varieties grown hydroponically for 21 days at concentrations of 0, 30, 60, 90 and 120 μM Cr in the form of potassium dichromate (K2Cr2O7). In both varieties, significantly deleterious effects on germination and seedling growth parameters were observed at 90 and 120 μM, while growth was stimulated at 30 μM Cr. Significant increases in malondialdehyde and hydrogen peroxide content and electrolyte leakage demonstrated enhanced oxidative injury to seedlings caused by higher concentrations of Cr. Further, increasing concentrations of Cr positively correlated with increased proline content, superoxide dismutase activity, and peroxide content in leaves. There was also an increase in peroxisomal ascorbate peroxidase and catalase in the leaves of both varieties at lower Cr concentrations, whereas a steep decline was recorded at higher Cr concentrations. In the pot experiments conducted over two consecutive years, growth, yield, yield attributes, grain protein, and Cr uptake and accumulation were measured at different Cr concentrations. Pusa Green 112 showed a significant reduction in plant growth, chlorophyll content, grain protein, pod number, and grain yield per plant when compared with Pusa 2085. Overall, our results indicate that Pusa 2085 has a higher Cr tolerance than Pusa Green 112. Therefore, Pusa 2085 could be used to further elucidate the mechanisms of Cr tolerance in plants and in breeding programmes to produce Cr-resistant varieties., Competing Interests: The authors have declared that no competing interests exist.

Due to increased sensitivity, the expression of circulating nucleotides is rapidly gaining popularity in cancer diagnosis. Whole blood mRNA has been used in studies on a number of cancers, most notably two separate studies that used whole blood mRNA to define non-overlapping signatures of prostate cancer that has become castration independent. Prostate cancer is known to rely on androgens for initial growth, and there is increasing evidence on the importance of the androgen axis in advanced disease. Using whole blood mRNA samples from patients with prostate cancer, we have identified the four-gene panel of FAM129A, MME, KRT7 and SOD2 in circulating mRNA that are differentially expressed in a discovery cohort of metastatic samples. Validation of these genes at the mRNA and protein level was undertaken in additional cohorts defined by risk of relapse following surgery and hormone status. All the four genes were downregulated at the mRNA level in the circulation and in primary tissue, but this was not always reflected in tissue protein expression. MME demonstrated significant differences in the hormone cohorts, whereas FAM129A is downregulated at the mRNA level but is raised at the protein level in tumours. Using published ChIP-seq data, we have demonstrated that this may be due to AR binding at the FAM129A and MME loci in multiple cell lines. These data suggest that whole blood mRNA of androgen-regulated genes has the potential to be used for diagnosis and monitoring of prostate cancer., (© 2016 Society for Endocrinology.)

Background: Understanding the heterogeneous genotypes and phenotypes of prostate cancer is fundamental to improving the way we treat this disease. As yet, there are no validated descriptions of prostate cancer subgroups derived from integrated genomics linked with clinical outcome., Methods: In a study of 482 tumour, benign and germline samples from 259 men with primary prostate cancer, we used integrative analysis of copy number alterations (CNA) and array transcriptomics to identify genomic loci that affect expression levels of mRNA in an expression quantitative trait loci (eQTL) approach, to stratify patients into subgroups that we then associated with future clinical behaviour, and compared with either CNA or transcriptomics alone., Findings: We identified five separate patient subgroups with distinct genomic alterations and expression profiles based on 100 discriminating genes in our separate discovery and validation sets of 125 and 103 men. These subgroups were able to consistently predict biochemical relapse (p = 0.0017 and p = 0.016 respectively) and were further validated in a third cohort with long-term follow-up (p = 0.027). We show the relative contributions of gene expression and copy number data on phenotype, and demonstrate the improved power gained from integrative analyses. We confirm alterations in six genes previously associated with prostate cancer (MAP3K7, MELK, RCBTB2, ELAC2, TPD52, ZBTB4), and also identify 94 genes not previously linked to prostate cancer progression that would not have been detected using either transcript or copy number data alone. We confirm a number of previously published molecular changes associated with high risk disease, including MYC amplification, and NKX3-1, RB1 and PTEN deletions, as well as over-expression of PCA3 and AMACR, and loss of MSMB in tumour tissue. A subset of the 100 genes outperforms established clinical predictors of poor prognosis (PSA, Gleason score), as well as previously published gene signatures (p = 0.0001). We further show how our molecular profiles can be used for the early detection of aggressive cases in a clinical setting, and inform treatment decisions., Interpretation: For the first time in prostate cancer this study demonstrates the importance of integrated genomic analyses incorporating both benign and tumour tissue data in identifying molecular alterations leading to the generation of robust gene sets that are predictive of clinical outcome in independent patient cohorts.

Purpose: In a recent phase II clinical trial, low-dose (100 mg/m(2)) gemcitabine showed promise as a radiosensitizer in bladder cancer, but underlying mechanisms lack elucidation. Here, we investigated the mechanism of radiosensitization by low-dose gemcitabine in bladder cancer cell lines., Experimental Design: Four bladder cancer cell lines were screened for radiosensitization by low-dose gemcitabine using clonogenic assay, and gemcitabine-resistant RT112gem and CALgem cells created by exposure to increasing gemcitabine doses. Four key gemcitabine-regulatory genes were knocked down by transient siRNA. Nude mice carrying CALgem subcutaneous xenografts were exposed to 100 mg/kg gemcitabine ± ionizing radiation (IR) and response assessed by tumor growth delay., Results: Gemcitabine was cytotoxic in the low nanomolar range (10-40 nmol/L) in four bladder cancer cell lines and radiosensitized all four lines. Sensitizer enhancement ratios at 10% survival were: RT112 1.42, CAL29 1.55, T24 1.63, and VMCUB1 1.47. Transient siRNA knockdown of deoxycytidine kinase (dCK) significantly reduced radiosensitization by gemcitabine (P = 0.02). RT112gem and CALgem cells displayed robust decreases of dCK mRNA and protein levels; reexpression of dCK restored gemcitabine sensitivity. However, CALgem xenografts responded better to combination gemcitabine/IR than either treatment alone (P < 0.001) with dCK strongly expressed in the tumor vasculature and stroma., Conclusions: Gemcitabine resistance in bladder cancer cell lines was associated with decreased dCK expression, but gemcitabine-resistant xenografts were responsive to combination low-dose gemcitabine/IR. We propose that dCK activity in tumor vasculature renders it gemcitabine sensitive, which is sufficient to invoke a tumor response and permit tumor cell kill in gemcitabine-resistant tumors., (©2014 American Association for Cancer Research.)

In prostate cancer (PC), the androgen receptor (AR) is a key transcription factor at all disease stages, including the advanced stage of castrate-resistant prostate cancer (CRPC). In the present study, we show that GABPα, an ETS factor that is up-regulated in PC, is an AR-interacting transcription factor. Expression of GABPα enables PC cell lines to acquire some of the molecular and cellular characteristics of CRPC tissues as well as more aggressive growth phenotypes. GABPα has a transcriptional role that dissects the overlapping cistromes of the two most common ETS gene fusions in PC: overlapping significantly with ETV1 but not with ERG target genes. GABPα bound predominantly to gene promoters, regulated the expression of one-third of AR target genes and modulated sensitivity to AR antagonists in hormone responsive and castrate resistant PC models. This study supports a critical role for GABPα in CRPC and reveals potential targets for therapeutic intervention., (© The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Introduction: Dermatophytosis is defined as the fungal infection of the skin, hair and nails by a group of keratinophillic fungi known as dermatophytes., Aims and Objectives: This study is an attempt to find out various species of dermatophytes in clinically suspected cases of dermatophytosis., Materials and Methods: One hundred samples were subjected to direct microscopy by potassium hydroxide wet mount (KOH) and isolation on culture with Sabourauds dextrose agar., Results: Out of these 80 (80%) samples were KOH positive while 20 (20%) were KOH negative. Overall culture positivity rate was 68%. Dermatophytosis was more common in males, the M:F ratio was 4:1., Conclusion: Total seven species were isolated on culture. Trichophyton rubrum (66.17%) was the commonest isolate followed by Trichophyton mentagrophytes (19.11%), Trichophyton violaceum (7.35%), Trichophyton tonsurans (2.94%) and one isolate each of Epidermophyton floccosum and Microsporum gypseum (1.47%).

Castrate-resistant prostate cancer (CRPC) is poorly characterized and heterogeneous and while the androgen receptor (AR) is of singular importance, other factors such as c-Myc and the E2F family also play a role in later stage disease. HES6 is a transcription co-factor associated with stem cell characteristics in neural tissue. Here we show that HES6 is up-regulated in aggressive human prostate cancer and drives castration-resistant tumour growth in the absence of ligand binding by enhancing the transcriptional activity of the AR, which is preferentially directed to a regulatory network enriched for transcription factors such as E2F1. In the clinical setting, we have uncovered a HES6-associated signature that predicts poor outcome in prostate cancer, which can be pharmacologically targeted by inhibition of PLK1 with restoration of sensitivity to castration. We have therefore shown for the first time the critical role of HES6 in the development of CRPC and identified its potential in patient-specific therapeutic strategies.

Psoriatic arthritis (PsA) is increasingly being recognized to cause progressive joint damage and disability. PsA unresponsive to non-steroidal anti-inflammatory drugs (NSAIDs), the conventional first-line choice of treatment, is usually managed with disease-modifying antirheumatic drugs (DMARDs) especially methotrexate. An 18-year-old HIV-negative male had progressively severe PsA of 4-month duration that was nearly confining him to a wheel chair. He did not respond to multiple NSAIDs, alone or in combination with methotrexate (15 mg/week), given for 4 weeks. Addition of prednisolone (10 mg on alternate days) controlled his symptoms within a week. The NSAIDs could be withdrawn after 4 weeks as the treatment progressed. The doses were tapered for methotrexate (5 mg/week) and prednisolone (2.5 mg on alternate days) every 8 weekly subsequently during 15 months of follow-up without recurrence/deformities or drug toxicity. For years, the use of corticosteroids in psoriasis has been criticized for their propensity to exacerbate the skin disease on withdrawal. However, monitored use of corticosteroids, even in low doses, combined with DMARDs may be a good therapeutic option in early stage of the PsA rather than 'steroid rescue' later. This will help in early control of joint inflammation, prevent joint damage and maintain long-term good functional capacity and quality of life. This may be useful when the cost or availability of biologics precludes their use. However, we discourage the use of corticosteroids as monotherapy.

The most significant and debilitating complication of herpes zoster (HZ) is herpetic neuralgia that accompanies and may persist in 10-15% of all zoster patients, particularly those over 60 years of age. The described 3 cases had an uncommon complication of spontaneous tooth exfoliation after trigeminal HZ that rarely finds mention in dermatology literature.

Many cancers display increased expression of histone deacetylases (HDACs) and therefore transcriptionally inactive chromatin, resulting in the downregulation of genes including tumour suppressor and DNA repair genes. Histone deacetylase inhibitors (HDACi) are a heterogeneous group of epigenetic therapeutics, showing promising anticancer effects in both pre-clinical and clinical settings, in particular the effect of radiosensitisation when administered in combination with radiotherapy. Radiotherapy remains one of the most common forms of cancer treatment, leading to cell death through the induction of DNA double-strand breaks (DSBs). Cells have developed mechanisms to repair such DSB through two major pathways: non-homologous end-joining and homologous recombination. Here, we explore the current evidence for the use of HDACi in combination with irradiation, focusing on the effects of HDACi on DNA damage signalling and repair in vitro. In addition, we summarise the clinical evidence for using HDACi with radiotherapy, a growing area of interest with great potential clinical utility.

The androgen receptor (AR) regulates prostate cell growth in man, and prostate cancer is the commonest cancer in men in the UK. We present a comprehensive analysis of AR binding sites in human prostate cancer tissues, including castrate-resistant prostate cancer (CRPC). We identified thousands of AR binding sites in CRPC tissue, most of which were not identified in PC cell lines. Many adjacent genes showed AR regulation in xenografts but not in cultured LNCaPs, demonstrating an in-vivo-restricted set of AR-regulated genes. Functional studies support a model of altered signaling in vivo that directs AR binding. We identified a 16 gene signature that outperformed a larger in-vitro-derived signature in clinical data sets, showing the importance of persistent AR signaling in CRPC., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives: To assess the impact of scaled-up sexually transmitted infection (STI) intervention under National AIDS Control Program (NACP) III and to examine the profile of STI/RTI clinic (now named Suraksha Clinic) attendees., Materials and Methods: A retrospective study by data analysis was done from April 2008 to March 2010. The scaled-up intervention comprised of (i) adopting enhanced syndromic approach, (ii) capacity building by appointing counselors and trainings of staff, (iii) strengthening STI/RTI clinics by provision of logistics and privacy by civil works, and (iv) supervisory support. The outcome which directly influenced service delivery was evaluated within this framework., Results: Sixteen "Suraksha Clinics" have been remodeled, equipped with supplies and laboratory set up. A total of 64,554 clinic visits were reported of which 27,317 [42%] attended the clinics for index STI/RTI complaint(s). Majority of the clients (44%) were young, 25-44 years old. Male to female ratio was 1:1.8. In females, the commonest complaint was lower abdominal pain (25%) and vaginal discharge (33%), the commonest syndrome. Amongst laboratory-confirmed STIs, 305 (1.4%) attendees were positive for trichomoniasis, while bacterial vaginosis was corroborated in 230 (1.07%) patients with clue cells. Amongst antenatal women, 251 were reactive for syphilis (≥1:8 dilutions). 10,579 partners of index STI/RTI patients were notified and partner management was attained to the level of 99%., Conclusion: Preliminary results show increased utilization of STI clinical services, though laboratory services need further strengthening. Continued supportive supervision and capacity building will enable skill development and quality monitoring.

Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by a unique susceptibility to cutaneous infection by a group of phylogenetically related human papilloma viruses (HPVs). These patients show a defect in cell-mediated immunity specific toward the causative HPVs that lead to lifelong disease. The defect is usually inherited as autosomal recessive trait and presents clinically with plane warts, pityriasis versicolor-like lesions and reddish verrucous plaques. Dysplastic and malignant changes in the form of actinic keratoses, Bowen's disease and squamous cell carcinoma (SCC) are common but metastasis occurs rarely. A totally effective treatment against EV is as yet highly desirable. Two siblings having autosomal dominant EV presented with multiple actinic keratoses in addition to classic lesions. One of them had also developed well-differentiated SCC over forehead with metastases to regional lymph nodes. They were treated with combination of excision of small malignant/premalignant lesions, topical 5-flurouracil and sun protection. Additionally, elective excision/grafting of large SCC was performed after chemotherapy/radiotherapy in patient with metastatic SCC. Oral acitretin (25 mg/day) was of benefit in the other patient. Overall clinicotherapeutic experience in both the patients is discussed here.

Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/available.

Background: Diabetes mellitus affects individuals of all ages and socioeconomic status. Skin is affected by the acute metabolic derangements as well as by chronic degenerative complications of diabetes., Aims: To evaluate the prevalence of skin manifestations in patients with diabetes mellitus. To analyze the prevalence and pattern of skin disorders among diabetic patients from this region of Western Himalayas., Materials and Methods: One hundred consecutive patients with the diagnosis of diabetes mellitus and having skin lesions, either attending the diabetic clinic or admitted in medical wards were included in this study., Results: The common skin disorders were: Xerosis (44%), diabetic dermopathy (36%), skin tags (32%), cutaneous infections (31%), and seborrheic keratosis (30%)., Conclusion: Skin is involved in diabetes quite often and the manifestations are numerous. High prevalence of xerosis in our diabetic population is perhaps due to cold and dry climatic conditions in the region for most of the time in the year.

Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimising outcomes. This article reviews the development and introduction of robotic-assisted laparoscopic radical prostatectomy (RALP), the results to date, and the possible future directions of RALP.

Background: The newly recognized endemic focus of leishmaniasis in Satluj river valley of Himachal Pradesh (India) has both localized cutaneous leishmaniasis (LCL) and visceral leishmaniasis (VL) predominantly caused by Leishmania donovani. Rapid rK39 immunochromatographic dipstick test detects circulating antibodies to recombinant K39 antigen of L. donovani-infantum complex and is highly specific/sensitive in diagnosing symptomatic or asymptomatic infection in humans and dogs., Methods: The sera from two VL patients and 13 LCL patients, and 31 dogs were subjected to rK39 immunochromatographic dipstick testing with an aim to identify possible animal reservoir for leishmaniasis in this endemic focus., Results and Conclusion: The positive rapid rK39 immunochromatographic dipstick test in 100% VL and 31.8% LCL patients, and 6.5% dogs suggests that both VL and LCL in this focus are apparently being caused by L. donovani-infantum and that reservoir infection is perhaps being chiefly maintained in asymptomatic dogs. However, it needs corroborative evidence in the form of in-vitro parasite cultivation and/or PCR studies for confirmation. A more elaborate study is recommended.

Nocardia spp are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia spp occur as a result of local trauma and contamination of the wound. Clinically, it presents as acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Differential diagnosis includes eumycetoma, chromomycosis, blastomycosis, coccidioidomycosis, sporotrichosis, tuberculosis, botryomycosis, syphilis, yaws, and neoplasia. Its diagnosis is confirmed by demonstrating the causative organism in exudates (as granules), tissue specimens, or cultures. Early diagnosis will obviate need for drastic surgical measures as early institution of chemotherapy is effective in most patients. However, its diagnosis is often delayed due to diverse clinical presentations and for want of clinical suspicion, particularly in non-endemic areas. This paper presents 4 clinical forms of this not so uncommon disease, emphasizing the importance of high index of clinical suspicion, especially in non-endemic regions; and the significance of repeated examination of exudates for Nocardia granules for an early diagnosis.

Objectives: To assess the seizure and developmental outcome in children with West syndrome with respect to treatment lag., Methods: Twenty-six children satisfying inclusion criteria of West syndrome i.e., infantile spasms, psychomotor retardation and abnormal EEG pattern were prospectively evaluated. Response to treatment was assessed based on seizure control, EEG, developmental assessment and parental observations., Results: The time lag from onset of seizures to appropriate treatment was <1 month in 11 children; 1-6 months in 8 children; and >6 months in 7 children. Children with treatment lag <1 month fared better than those who had a large treatment lag (P<0.05). Children with good seizure control also showed better developmental improvement (P<0.05)., Conclusion: Children with West syndrome have better seizure control and development, if the treatment is started within 1 month of onset of symptoms.

Background: Despite worldwide prevalence of hirsutism studies on hirsutism in Indian patients are not many., Aims: This retrospective study was carried out to assess the clinico-investigative profile of patients presenting with hirsutism., Materials and Methods: Medical records of 82 hirsutism patients diagnosed consecutively during July 2005 to October 2007 were analyzed., Results: The complete data of 50 patients aged between 13 and 47 years were available. Fifty percent patients were aged 20 to 30 years. The average F-G score was 10.3 +/- 2.46. Associated signs of hyperandrogenism were acne (64%), oligomenorrhea or menstrual irregularities (36%), androgenetic alopecia (16%), acanthosis nigricans (6%) and seborrhea (4%). Polycystic ovaries were detected in 30% patients and 22% patients had elevated serum free testosterone levels. Family history of hirsutism was present in 18% patients., Conclusion: Hirsutism in Indian patients is not uncommon. Adolescent patients appear to be more concerned about hirsutism as compared to those in the older age group who were more often worried of late onset acne. All patients, however, were more concerned for facial hair than those on other body areas signifying that facial hair need to be given higher than current value in F-G score.

Background: Onychomycosis is a common nail infection caused by dermatophytes, yeast or other nondermatophyte molds and has diverse clinical presentations. Although common in this part of the country, no significant clinico-mycologic data is available., Objectives: This study was carried out to document the clinico-mycologic pattern of onychomycosis in Himachal Pradesh (India)., Methods: All consecutive patients of onychomycosis diagnosed clinically during March 2005 to February 2006 were studied for clinical forms, number of nails involved and severity of infection. The clippings from the most severely affected nails were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud's dextrose agar., Results: These 130 patients (M:F 98:32) were between 8-76 years of age (mean 41.35 +/- 14.98 years). The prevalence of onychomycosis was higher among farmers and office workers (20% each). Finger or toe nails were exclusively involved in 56.9 and 32.3% patients respectively while these were involved concurrently in the rest of the 10.8% patients. Distal and lateral subungual onychomycosis seen in 73.1% of the specimens was the most common clinical type. KOH- and culture-positivity were recorded in 59.2 and 37.6% cases respectively. Dermatophytes and yeast (Candida albicans) were isolated in 40.8% each of the cultured nail specimens while nondermatophytic molds (NDM) were cultured in 18.6% of the samples. Various dermatophytes cultured were Trichophyton rubrum (32.6%), T. mentagrophytes (6.1%) and T. verrucosum (2.1%) respectively. Aspergillus spp. (6.1%) was the most commonly isolated NDM while other detected molds were Acremonium spp, Fusarium spp,, Scopulariopsis spp, Curvularia spp. and Penicillium marneffei. Peripheral vascular disorders (7.69%), occupational trauma (13.8%), close association with animals (60.78%) and a family history of onychomycosis (26.15%) were a few of the predisposing factors identified., Conclusion: Onychomycosis is not uncommon in this part of the country and has similar clinico-mycologic profiles in the different cases detected.

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.

Cutaneous sporotrichosis, a subcutaneous mycotic infection is caused by the saprophytic, dimorphic fungus Sporothrix schenckii. It commonly presents as lymphocutaneous or fixed cutaneous lesions involving the upper extremities with facial lesions being seen more often in children. The lesions are polymorphic. The therapeutic response to saturated solution of potassium iodide is almost diagnostic. We describe a culture-proven case of cutaneous sporotrichosis of the face mimicking lupus vulgaris initially and basal cell carcinoma later, who did not tolerate potassium iodide and failed to respond to treatment with fluconazole. The patient had reactivation of infection following an infiltration of the scar with triamcinolone acetonide injection. Various other aspects of these unusual phenomena are also discussed.

Background: Sarcoidosis is a multisystem disease of undetermined etiology. Indian studies on cutaneous sarcoidosis are not many and mainly comprise case reports., Aims: This retrospective study was carried out to assess the clinical profile of sarcoidosis patients presenting with cutaneous lesions., Methods: All histopathologically proven cases of cutaneous sarcoidosis seen consecutively between 1999 and 2004 were studied. Their age, sex, presenting features, evolution of disease and laboratory parameters were analyzed., Results: A total of 23 patients (F:M 15:8) between 31 to 78 years (mean 44.3 years) of age had the mean duration of skin lesions of 1.4 years. Six patients had one to four lesions; two patients each had scar sarcoidosis and angiolupoid and one patient each had recurrent erythema nodosum, leg lymphedema and subcutaneous sarcoidosis. Others showed combination of papules, nodules, plaques and psoriasiform lesions. Peripheral lymph nodes were involved in two patients. Among 10 patients of pulmonary involvement, three had become symptomatic four months to four years after the cutaneous lesions. Routine laboratory investigations including serum calcium estimation were normal in all cases. Serum angiotensin-converting enzyme levels were raised in 3 out of 6 patients. Asymptomatic lytic lesions of digital bones were detected in hand X-ray of one patient., Conclusion: Skin lesions of sarcoidosis are like the tip of an iceberg indicating more changes in other organs. The symptomatology and abnormal laboratory results do not necessarily correlate with the severity of cutaneous involvement in general.

Acrokeratosis paraneoplastica of Bazex is a rare syndrome. This condition is a distinct skin marker of supra-diaphragmatic neoplasia. This syndrome is important because the cutaneous findings preceed the onset of symptoms referable to the underlying neoplasm by several months in majority of the cases. We report here a case of a 63-year-old cachectic female who had classic psoriasiform lesions of acrokeratosis of Bazex with underlying bronchogenic carcinoma of the right lung.

The differential diagnosis of oral ulcerations in a patient with AIDS/HIV infection is often challenging to the clinician. While old diseases have appeared in a new garb, many new ones are also being recognized. The association of Behetaet's disease and AIDS/HIV infection has been recently recognized. We present an HIV-positive patient having oro-genital aphthosis conforming to the diagnostic criteria for Behetaet's disease. Erythema nodosum, periphlebitis, erythematous papulopustular lesions, half and half nails, ocular congestion, raised ESR and dimorphic anemia were some other features present. He had low CD4+/CD8+ counts. He had no other HIV-related disease. He responded well to triple anti-retroviral treatment alone. The possible pathomechanism of the occurrence of both diseases is also discussed.

Localized cutaneous leishmaniasis (LCL) in India is due mostly to Leishmania tropica. It is mainly endemic in the deserts of Rajasthan. Recently, Himachal Pradesh has been identified as a new endemic focus for the disease. In the last few years, the number of new cases has been increasing almost to epidemic proportions. This report presents the preliminary findings of clinico-epidemiologic and investigative results of 161 new localized cases of LCL seen between May 2001 and December 2003. The study populaton was composed of 80 males and 81 females between 10 months and 75 years of age. All were indigenous to the sub-alpine valley along the Satluj River in the mountainous region of the Kinnaur District (altitude = 700-2,900 meters). Most patients were seen from April to September and had 1-8 lesions (duration = 1-6 months) that involved mainly the face. Tissue smears were positive for amastigotes in 37% and histopathology showed non-caseating epitheloid cell granuloma in 77% of the cases. Analysis by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the ribosomal gene region of 10 biopsy specimens showed amplicons indistinguishable from L. donovani in eight cases and L. tropica in two cases. Leishmania was cultured on modified Nicole-Novy-McNeal (NNN) medium containing RPMI 1640 medium and heat-inactivated fetal bovine serum from 13 of 38 biopsy samples. Three of these isolated strains were identified as L. donovani while a fourth was L. tropica by PCR-RFLP of the ribosomal internal transcribed spacer region. One strain had a gp63 sequence identical to that of east African strains. Another strain had a unique gp63 sequence that has not been found in L. donovani complex strains. Sand flies trapped in the cattle sheds of a few patients were identified as Phlebotomus longiductus (Parrot 1928). Treatment with intralesional sodium stibogluconate was effective in all patients without any major side effects. One patient developed lupoid leishmaniasis that responded to higher dose of sodium stibogluconate. Though rarely reported as a cause of LCL, L. donovani seems to be the predominant pathogen in this new focus of cutaneous leishmaniasis. Phlebotomus longiductus is a possible vector, albeit based on circumstantial evidence.

Papillon- Lefèvre syndrome (PLS) is a rare autosomal recessive disorder of keratinization characterized by palmoplantar hyperkeratosis, periodontopathy and precocious loss of dentition. The exact pathomechanism of these clinical events mainly remains speculative. This paper describes two cases of PLS with classic clinical features and briefly review the relevant literature.