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Background: A lot of cosmetic and Ayurvedic products containing unlabeled depigmenting agent and steroids are available readily over the counter sale. The side effects of these products are not documented and can lead to adverse effects of continuous usage. Objective: By this study, we aimed to find out the true nature of the above problem and it's implication in the Indian rural scenario. Methodology: All patients attending dermatology department during the period of 3 months from May to June 2013 for skin diseases were enquired about unsupervised use of any cosmetic product on their facial skin, duration of use, any side effect experienced through the prescribed questionnaire. Results: Total 50 patients were recruited for the study. Out of which, 48% were males and 52% were females. Seventy-four percent of people had applied topical products/steroids in an attempt of attainment of fair complexion, 14% for melasma, 8% for acne induced hyperpigmentation, and 4% for dark circles. About 80% people had obtained one or the other products over the counter sale, 8% had followed the attractive advertisements, 8% had started the application on the recommendation of friends/family while only 4% people had correctly gone through the proper channel to consult a dermatologist. Conclusion: The problem of topical products or steroids abuse is rampant and significant, and unless and until immediate steps are taken to root out this problem from our setup, the condition will become worse all the more.

We report a case of a 27 year old male with heart shaped itchy, erythematous scaly lesions with well defined margin on lower abdomen for 6 weeks with history of similar skin complaint in spouse since 3 months. Patient got married 4 months back. DOI: http://dx.doi.org/10.3126/hren.v11i3.9654 Health Renaissance 2013;11(3):279-280

Erythema ab igne (EAI) is characterized by localized areas of reticulated erythema and hyperpigmentation due to chronic and repeated exposure to infrared radiation. Taking a good history plays an important role in coming to the diagnosis of the disease condition; and at the same time, the particular cultural practices of a place determine its occurrence in the local masses. Herein we report the case of a young lady in her early thirties who presented to us with a dusky hyperpigmentation over her right arm and leg. Her detailed history and cutaneous examination led to the diagnosis of erythema ab igne.

22 year old male came to Skin department with grouped vesicles over sternal region since birth along with serous discharge. The biopsy taken from site showed histopathologically Lymphangioma circumscriptum. It was treated with CO2 Laser, and response was good. Health Renaissance; September-December 2012; Vol 10 (No.3);256-257 DOI: http://dx.doi.org/10.3126/hren.v10i3.7059

Madarosis is window of diagnosis to various diseases and disorders. Though the patient presents to the dermatologist or the ophthalmologist for the treatment of this disease, a consultation with various other departments is necessary for the accurate diagnosis and treatment of this condition. Madarosis occurs in leprosy frequently but its occurrence as a presenting manifestation of leprosy has seldom been reported. Here, we are presenting a case of lepromatous leprosy who presented with bilateral madarosis only with no obvious skin lesions of leprosy.

We report a case of a 3-year-old male child presenting with a polymorphous generalized eruption consisting of crusted maculopapular lesions all over body except for face and mucus membrane. Histopathology showed interface dermatitis along with perivascular infiltrates chiefly comprising of lymphocytes and extravasated red blood cells, indicating the diagnosis of pityriasis lichenoides et varioliformis acuta. He was treated with dapsone and eryhthromycin with success.

Background: Hypertension is one of the leading causes of global burden of disease. Uncontrolled hypertension is associated with long term risk of damage to vital organs like brain, heart, kidney, blood vessels and eye i.e. Target Organ Damage (TOD). Medical scientists all over the world have been in search for an indicator which can accurately predict TOD. It is accepted that Microalbuminuria (MA) represents a more generalised vascular problem, not only confined to renal microcirculation. MA is found in a significant proportion of non-diabetic population, particularly in association with hypertension and is a predictor of cardiovascular disease. The objective of the study was to evaluate MA in hypertension and its correlation with TOD. Methods: A Hospital based cross sectional study carried out in the department medicine of central referral hospital, a well-equipped tertiary care hospital in East Sikkim, Gangtok. 200 patients were recruited fulfilling the inclusion criteria of pre hypertension, stage 1 & 2 hypertension as defined by JNC 7 report. Patients with secondary hypertension, DM, ESRD & hyperuricemia were excluded. MA was estimated by Immunoturbidimetry. Results: MA is associated with all TOD but significant correlation was found only with retinopathy. Out of 200 study subjects, 90 (45%) subjects had retinopathy out of which 54 (60%) had MA and 36 (40%) did not have MA. (P

Nicolau syndrome (embolia cutis medicamentosa) is a rare cutaneous adverse reaction occurring at the site of intramuscular, intra-articular or, rarely, subcutaneous injection of particular drugs. We hereby report a fatal case of Nicolau syndrome in a 13-year-old young male patient.

Background: Moraxella catarrhalis (M. catarrhalis) is a common pathogen in the human upper respiratory tract. This microbe is also implicated in chronic lower respiratory tract infections as well as conjunctivitis, sinusitis, meningitis, otitis media, osteomyelitis, endocarditis, etc. Objectives: This study was carried out to know various facets of M. catarrhalis infection among adults with bronchopulmonary infections and the related antibiotic susceptibility pattern. Materials and Methods: A hospital-based study was carried out among adult participants with history of respiratory tract infection admitted to a tertiary care teaching hospital in Karnataka during the period of May 2007 to April 2010. A total of 912 early morning sputum samples were collected, processed with standard procedures, and analyzed. Results: Out of all the sputum samples, M. catarrhalis was the third most important pathogen (16.01%). Most of these M. catarrhalis isolates were sourced from participants with bronchopneumonia (31.51%), followed by chronic bronchitis (25.34%), bronchiectasis (25.34%), and bronchial asthma (17.81%). M. catarrhalis infection was predominantly noted among males (78.08%) and in older age group (22.60%), i.e., 61-70 years. All strains of M. catarrhalis were sensitive to tetracycline, co-trimoxazole, chloramphenicol, and gentamicin; 75.34% were resistant to penicillin, ampicillin, and amoxycillin. Surprisingly, all strains were resistant to erythromycin; 37 (25.34%) were beta-lactamase positive. Conclusions: M. catarrhalis is one of the emerging pathogens in bronchopulmonary infections, and the beta-lactamase-producing strains imply its ability for antibiotic resistance.

Background: Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce these factors by early diagnosis and proper management. Aim: The aim of the study was to analyze the bacteriological profiles with their antibiogram, and to register the risk factors for septicemia in neonates and infants. Setting and design: This observational cross-sectional study was conducted in a tertiary care teaching hospital at Gangtok, Sikkim, India, and included clinically suspected cases of septicemia in neonates and infants. Materials and Methods: Blood culture reports were studied in 363 cases of clinically suspected septicemia in neonates and infants, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer′s disc diffusion method. Risk factors for sepsis in the children were registered. Results: Blood culture was positive in 22% of cases. Gram-negative septicemia was encountered in 61% of the culture-positive cases. Pseudomonas and Enterobacter species were the predominant pathogens amongst gram-negative organisms. Most gram-negative organisms were sensitive to Amikacin, Ciprofloxacin, and Co-trimoxazole. The most common gram-positive organism isolated was Staphylococcus aureus (97%). More than 70% of Staphylococci isolated were resistant to Penicillin, but were sensitive to Clindamycin (70%) and Vancomycin (40%). The most important risk factors of septicemia in our study population were preterm birth (31%), followed by respiratory distress (5%) and low birth weight (4%). Conclusion: As the cultures showed variable antibiogram with complicated patterns of resistance, culture and sensitivity test should be performed in all cases of septicemia.

Background: In the preoperative decision-making of the thyroid swellings, fine needle aspiration cytology (FNAC) is becoming an ever more vital tool. Objectives: To compare the advantage of preoperative FNAC of thyroid swellings with postoperative histopathology to reach a consensus protocol as a simple procedure for diagnosis and optimal management of thyroid swellings. Materials and Methods: A prospective study of preoperative FNAC was carried out on 178 incidental thyroid swellings attending a tertiary care centre in Kishanganj, Bihar. Evidence-based surgical interventions were done, irrespective of FNAC findings and diagnosis was confirmed by histopathological examination (HPE) postoperatively in all the cases. Results: In the FNAC, preponderance of the cases (75.84%) was colloid goitre followed by granulomatous thyroiditis; follicular carcinoma was noted in 7.30 percent and anaplastic carcinoma in 3.37 percent of cases. Histopathological examination showed colloid goitre predominantly (76.97%), followed by follicular carcinoma (8.99%). The overall prevalence of malignancy was 11.24 percent diagnosed by HPE and 9.55 percent by FNAC. In our FNAC series sensitivity of was 90 percent while specificity was 100 percent; accuracy was 98.88 percent. Predictive value of a positive test and negative tests was 100 percent and 98.75 percent respectively. Conclusion: The study highlights that FNAC should be treated as a first-line diagnostic test for thyroid swellings to guide the management though this is not a substitute for HPE as a need to improve primary healthcare in India.

Background: Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains is reported to be increasing globally. Objectives: The study was conducted to find the magnitude and antibiotic susceptibility pattern of MRSA infection in a referral tertiary care teaching hospital of Sikkim, India. Materials and Methods: In this cross sectional study, 827 clinical specimens were collected from different departments of Central Referral Hospital. One hundred and ninety-six carrier screening nasal swabs were obtained from health care workers of the hospital. Subsequently, the antimicrobial susceptibility test was performed for the confirmed MRSA isolates as per Clinical and Laboratory Standards Institute (CLSI). Results: Methicillin resistance was seen in 152 isolates of S. aureus - 111 from clinical specimens and 41 from carrier screening samples. MRSA positivity among males was significantly higher than females. Extremely significant MRSA-positive cases were observed from ages less than 30 years, in-patient cases, particularly with a stay of more than 15 days and with a previous history of intake of broad spectrum antibiotics. Incidentally, there was no significant difference of MRSA positivity with a previous history of hospitalization. The extent of MRSA and drug resistance pattern was significantly different among various samples of S. aureus-positive isolates. The strains tested exhibited decreased susceptibility to vancomycin and imipenem. Most vulnerable of the carrier were the cleaners, that was a significant observation. Incidentally, there was no resistance in the carriers to both vancomycin and imipenem. Conclusion: MRSA is prevalent in our hospital and strains resistant to methicillin and vancomycin were quite high.

Background : Post-operative cognitive dysfunction is the subtle cerebral complication temporally seen following surgery. The aim of this study was to compare the influence of either general anesthesia (GA) or epidural anesthesia (EA) on the early post-operative neurocognitive outcome in elderly (>59 years) subjects undergoing hip and knee surgery. Methods : A total of 60 patients were recruited in a prospective, randomized, parallel-group study, comparable by age and sex. They were enrolled and randomized to receive either EA (n = 30) or GA (n = 30). All of them were screened using the Mini Mental State Examination (MMSE), with components of the Kolkata Cognitive Screening Battery. The operated patients were re-evaluated 1 week after surgery using the same scale. The data collected were analyzed to assess statistical significance. Results : We observed no statistical difference in cognitive behavior in either group pre-operatively, which were comparable with respect to age, sex and type of surgery. Grossly, a significant difference was seen between the two groups with respect to the perioperative changes in verbal fluency for categories and MMSE scores. However, these differences were not significant after the application of the Bonferroni correction for multiple analyses, except the significant differences observed only in the MMSE scores. Conclusions : We observed a difference in cognitive outcome with GA compared with EA. Certain aspects of the cognition were affected to a greater extent in this group of patients undergoing hip and knee surgery.

Background: Limited data is available from India regarding the distribution and profile of childhood obesity and hypertension. Materials and Methods: A population based cross-sectional study was conducted in the urban schools of Kolkata. Using stratified random sampling method, 979 participants were selected. Body mass index (BMI) status and blood pressure (BP) were estimated using standard protocol and their various correlates regarding sociodemographic characteristics were looked into. Results: Majority (38.92%) of the study population were in the preadolescent group followed by adolescent group (33.40%). Male constituted 52.09%, overweight was more prevalent among preadolescent age group (22.57%). Overall 27 cases of prehypertension were found of which 19 (70.37%, n=27) were in the adolescent age group. There was no significant association between ages with increased BMI status. We detected total 15 cases (1.53%) of hypertension in our study population and three-fourths of them were from adolescent age group. However, significant association was seen between high BP with increasing age. Average fast food intakes and screen time was higher in obese as compared to their normal peers. Upper and upper-middle social status contributed to higher number of obese/overweight and hypertensive children and was the significant risk factor. Conclusion: Childhood obesity and hypertension were found to be common in the city of Kolkata which suggest the need for greater public awareness programs on these morbidities.

Address for Correspondence: Ankit Shrivastav, MD, 242, Ajc Bose Road 700020 Kolkata, India Tel: +919883252055 E-mail: ankit.med@gmail.com A 55-year-old male presented with a superficial mass over the right leg that had gradually progressed over the last month. The lesion was pruritic and painful. It was firm, indurated, shiny, erythematous, and raised on the surface (Figure 1). There was no lymphadenopathy or hepatosplenomegaly. All routine parameters including bone marrow biopsy were normal. An incision biopsy was taken from the lesion, which revealed superficial and deep perivascular, nodular and interstitial, bottom-heavy infiltrate comprised predominantly of lymphocytes, which showed a marked crush artifact (Figures 2-4). There were some preserved lymphocytes with enlarged, slightly hyperchromatic nuclei with basophilic nuclei. The epidermis and adnexal structures were spared. Immunological staining revealed a predominance of CD20positive B-cells, which were bcl-2-positive. A diagnosis of primary cutaneous diffuse large B-cell lymphoma, leg type was made. The patient was treated with the cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) regimen. Rituximab was not added to the regimen as the patient could not afford it. He did not respond to the treatment and was lost to follow-up.

Objective: In childhood Guillain-Barre syndrome (GBS), the clinical profiles using intravenous immunoglobulin (IVIg) in addition to supportive care were studied. Materials and Methods: This was a retrospective analysis of 139 children with severe GBS admitted to our respiratory care unit managed with the IVIg as an adjunct intervention to conventional supportive and respiratory care. Results: In our case series of 139 cases, motor weakness was the most common presenting feature. Antecedent illness was found in 66.7% of cases in the preceding two weeks, which included nonspecific illness, acute respiratory infection, diarrhea, and chickenpox. At onset, sensory symptoms (pain and paresthesia) were noted in 59% of the cases and limb weakness in 77%. On admission, a majority (61.54%) were in Hughes neurological disability grading stage V; all had limb weakness at the peak deficit, autonomic disturbance was seen in 35.8%, and bulbar palsy in 52%. Duration of illness was less than three weeks in 67% of cases. The mean duration of ventilation was 21.5 days (range, 5-60 days). Conclusions: Male preponderance and motor weakness was the most common presenting illness and a majority achieved full recovery in our series. Although IVIg may be useful in the treatment of GBS, the key issue is excellent intensive care unit management.

Background: Solar radiations improve the microbiological quality of water and offer a method for disinfection of drinking water that requires few resources and no expertise and may reduce the prevalence of diarrhea among under-five children. Aims and Objectives: To find out the reduction in the prevalence of diarrhea in the under-five children after consumption of potable water treated with solar disinfection method. Materials and Methods: This was a population-based interventional prospective study in the urban slum area of Mazegoan, Jorethang, south Sikkim, during the period 1 st May 2007 to 30 th November 2007 on 136 children in the under-five age group in 102 households selected by random sampling. Main outcome measure was the assessment of the reduction of the prevalence of diarrhea among under-five children after consumption of potable water treated with solar disinfection method practiced by the caregivers in the intervention group keeping water in polyethylene terephthalate (PET) bottles as directed by the investigators. The data were collected by the interview method using a pre-tested questionnaire prepared on the basis of socio-demographics and prevalence of diarrhea. The data were subjected to percentages and chi-square tests, which were used to find the significance. Results: After four weeks of intervention among the study group, the diarrhea prevalence was 7.69% among solar disinfection (SODIS) users, while 31.82% prevalence was observed among non-users in that period; the reduction in prevalence of diarrhea was 75.83%. After eight weeks of intervention, the prevalence of diarrhea was 7.58% among SODIS users and 31.43% among non-users; the reduction in diarrhea was 75.88% in the study group. The findings were found to be statistically significant. Conclusions: In our study, we observed that the prevalence of diarrhea decreased significantly after solar disinfection of water was practiced by the caregivers keeping potable water in PET bottles in the intervention group.

Background Dermatoglyphics is a scientific study of epidermal ridges and their configuration on the volar skin. It is not established whether there is definite dermatoglyphic pattern which exists with vitiligo. Objectives To study the finger and palmar dermatoglyphic patterns in vitiligo patients. Methods The study included a total 112 cases of vitiligo and 104 controls. Handprints of palmar surface and rolled fingerprints of 10 digits were subjected to detailed digito-palmar dermatoglyphic analysis. Results Male patients had increased percentage of total loops, total ulnar loops and finger ridge counts and increased true palmar patterns (TPP) in right hypothenar, right thenar and both interdigital area (ID)2. Decreased percentage of total radial loops, total whorls, total arches, TPP in right ID3, right ID4 and absolute finger ridge count was noted in male patients. Female cases showed an increased number of arches, true palmar pattern in right hypo- thenar, right ID1 and a-b ridge count along with decreased number of total loops, total ulnar loops, total radial loops, whorls, total finger ridge count, absolute finger ridge count, TPP in right ID2 and left ID3. In both the sexes, atd angle was found to be increased.

A 55 year old female came to Skin OPD with extensive pruritic annular papules and plaques over both upper limbs, lower limbs, back and abdomen. Biopsy from one of the lesion confirmed histopathologiclly Granuloma annulare. This case is being presented for its extensive skin involvement without any systemic disorder. Keywords: Generalized Granuloma Annulare DOI: http://dx.doi.org/10.3126/hren.v9i3.5592 HR 2011; 9(3): 207-209