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Conversion disorder is not normally listed amongst the conditions in differential diagnosis of leprosy neuropathy. A case conversion reaction who was initially diagnosed as neuritic leprosy is reported. Patient responded to narcosuggestion and psychotherapy.

Abstract: Background: Trends in mode of detection of HIV infection in the Armed Forces required to be analyzed to formulate future strategies for early detection. Methods: A retrospective study was thus conducted in 612 newly diagnosed HIV-positive cases between January 1997 to August 2002. Results: 182(29.74%) patients had already developed Category C conditions when detected to be HIV-positive, 176(96.70%) with mycobacterial disease, majority (67.61%) of them being pulmonary tuberculosis, followed by recurrent bacterial pneumonia in 3 (1.65%), pneumocystis carinii pneumonia (PCP) in 2(1.1%) and oesophageal candidiasis in one (0.55%). Herpes zoster was the third most common mode of detection accounting for 86 (14.05%) of the cases (24.6% of them with involvement of ophthalmic branch of trigeminal nerve), after tuberculosis in 176(28.76%) and blood donors in 98(16.01%), followed by constitutional symptoms in 59(9.64%) cases, investigation for STDs in 56(9.15%), bacterial pneumonia in 6(0.98%) and oral mucosal candidiasis in only one (0.16%) case. None was detected during acute retroviral illness and only 5(0.82%) cases were detected while being investigated for generalized lymphadenopathy. Amongst the cases detected during investigation for STDs, majority (26.79%) were on STD surveillance. 22(3.60%) cases tested positive when their spouses were detected to be HIV-positive, 20(3.27%) while being screened for surgery, 4(0.65%) for posting abroad and 2(0.32%) each during investigation when child was found HIV-positive and investigation for HBV infection. Remaining 69(11.27%) patients were detected during investigation of various related or unrelated conditions including one (0.16%), which reported voluntarily after a high-risk exposure. Conclusion: There is a need to encourage voluntary reporting and identify more number of cases during acute retroviral syndrome and PGL stage. [Copyright &y& Elsevier]

Background: Platelet-rich plasma (PRP) has shown remarkable beneficial effects without any major adverse reactions in the treatment of androgenic alopecia. The growth factors in activated autologous PRP induce the proliferation of dermal papilla cells., Objectives: The objective was to investigate the clinical efficacy of PRP in treatment of androgenic alopecia., Materials and Methods: Ten patients were given autologous PRP injections on the affected area of alopecia over a period of 3 months at interval of 2-3 weeks and results were assessed., Results: Three months after the treatment, the patients presented clinical improvement in the hair counts, hair thickness, hair root strength, and overall alopecia., Conclusion: PRP appears to be a cheap, effective, and promising therapy for androgenic alopecia with no major adverse effects.

Many bracket base designs and adhesive materials are in clinical use today. Bases have evolved from perforated metal bases to the present foil mesh bases, and treatments range from none, to spraying metal alloy onto the base, to the most common treatment of microetching. The purpose of this study was to determine the effect of orthodontic bracket base design on mean shear bond strength 1 hour or 24 hours after bonding. For each time group, 12 specimens of 6 types of metal brackets were bonded to bovine incisors with Transbond XT (3M Unitek, Monrovia, Calif) light-cured composite resin. Brackets were debonded 1 hour or 24 hours later, and the shear bond strength was recorded. Six debonded brackets of each type from each time group were selected at random and sandblasted. All the teeth were cleaned, and half were rebonded with used brackets, and half were rebonded with new brackets. Bond strength was measured again, 1 hour or 24 hours later. Representative specimens were inspected under the scanning electron microscope. Bracket base design significantly affected mean shear bond strength. Speed (60-gauge, microetched foil-mesh base; Strite Industries, Cambridge, Ontario, Canada) had the highest bond strength at 1 hour; followed by Time (machined, integral, microetched base with mechanical undercuts; American Orthodontics, Sheboygan, Wis); American Master Series (80-gauge foil-mesh base; American Orthodontics); Ovation Roth (80-gauge layered onto 150-gauge, microetched foil-mesh base; GAC, Central Islip, NY); Orthos Optimesh XRT (100-gauge microetched foil-mesh base; Ormco, Orange, Calif); and, finally, the nickel-free brackets (injection molded, 100-gauge, microetched, foil-mesh base; World Class Technology, McMinnville, Ore). The 24-hour results were similar except that Time had the highest mean shear bond strength (ANOVA, P <.05). Chairside sandblasting significantly affected the 1-hour, but not the 24-hour, mean shear bond strengths (ANOVA, P <.05). Sandblasting appears to be an effective method of cleaning bracket bases before rebonding.

Papillary endothelial hyperplasia (Masson's tumour) is a reactive proliferation of endothelium producing papillary structures with fibrovascular cores. Dilatation, stasis and accompanying inflammation have been incriminated as the inciting events, evident by the presence of this lesion in haemorrhoids, urethral caruncles and laryngeal polyps. We present here a case of papillary endothelial hyperplasia in angiokeratoma hitherto undescribed despite sharing common etiopathogenetic features of dilatation and stasis with other aforementioned lesions.

A clinics-bacteriological study of 52 patients with urethritis was carried out. All the patients were evaluated clinically and bacteriologically at the beginning and end of the treatment. Majority of the patients belonged to the age group 21-30 years (58%). Incidence of gonococcal urethritis was 65% and Non gonococcal Urethritis (NGU) 35%. The common organisms causing NGU were chlamydia (28%) ureaplasma (11%) and mycoplasma (11%). Neisseria gonorrhoea was resistant to penicillin in (38%), ciprolloxacin in 67, and to noriloxaein in 6% cases. High incidence of HIV positivity was found in gonorrhoea (21%).

Background: A variety of renal lesions have been reported in HIV positive patients from western world however there is paucity of Indian data., Methods: Over a four year period, all hospitalised HIV positive patients were screened for renal involvement. Screening was done with urinalysis. Those with abnormality in urine examination underwent further assessment with clinical, biochemical, immunological profile and renal biopsy. Renal histology was studied by light and electron microscopy., Results: Twenty-five (17.6%) of the 142 patients screened, had proteinuria/abnormal urinary sediment however none of the patient had proteinuria in nephrotic range. Fourteen of these 25 patients were asymptomatic while others had AIDS. Renal biopsy was studied by light microscopy in all and by electron microscopy in 11 cases. On histology mesangioproliferative GN was encountered in eight, focal segmental glomerulosclerosis in four and collapsing GN in one patient. In two cases cryptococcal infiltration and in one lymphomatous deposits were seen in glomerulus and interstitium. In one patient interstitium showed granulomas and in other three mononuclear cell infiltration. Histology was normal in 8 (32%) patients. On EM visceral cell hyperplasia and vacuolisation was seen in all, two had collapse of glomerular basement membrane and in three cases tubuloreticular structures were seen. There was no co-relation of renal histology with duration or severity of the disease (p > 0.05). No deterioration of renal function was seen over a short follow up period of 4.2 months (1-20 months)., Conclusion: This study highlights that HIV patients exhibiting abnormal urinary sediment usually have underlying renal lesion and at times unexpected opportunistic infections may be present.

A total of 1027 male patients suffering from sexually transmitted diseases (STD) during 1990 to 1996 were screened for HIV infection. All cases were in the age group 17 years to 48 years. One hundred and sixty-seven STD cases (16.3%) were found to have HIV infection. A rising trend in incidence of HIV infection in STD patients from 1990 (2.8%) to 1996 (27.8%) was noticed countrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The incidence of HIV infection was 30.3% in lymphogranuloma venereum, 19.5% in chancroid, 13.5% in syphilis, 17.6% in herpes genitatis, 6.7% in gonorrhoea and 11.2% in other STD cases.

A total of 320 patients of more than 60 years of age were studied for dermatological changes with aging. The male female ratio of patients was 3:1. Majority of cases (60.6%) were between 60-65 years of age. Pruritus was present in 37.5% cases, wrinkles in 82.1%, senile lentigenes in 57.8%, seborrhoeic keratosis in 48.8%, cherry angioma in 48.1%, idiopathic guttate hypomelanosis in 43%, skin tags in 37%, xerosis in 28%, comedones in 19%, infection and infestation in 40%, eczematous disorders in 36.9%, papulosquamous disorders in 10%, metabolic disorders in 16%, pigmentary disorders in 8.7%, keratinisation disorders in 4.1%, vesiculobullous disorders in 2.8% and associated systemic disorders in 49.7% cases.

A total of 300 patients from first day of life to 17 years of age were analysed for pattern of skin disorders. School going children formed majority (41.3%) of cases followed by preschool children (32%). Infections formed the commonest disorder (31 %) followed by eczemas (24%), papulosquamous disorders (12%), infestation (8.6%) and urticaria (5.3%) while vitiligo, acne vulgaris, alopecia areata and genodermatoses were seen in 2.7% cases each.

A 40-year old male presented with typical features of leprosy borderline tuberculoid (BT) type. During the course of treatment, he developed neurological features which were initially attributed to neuritis. However, these features progressed despite antileprosy treatment. Detailed investigations revealed compressive myelopathy due to cervical canal stenosis. He was managed successfully with appropriate surgical treatment.

Three cases of concurrent infection with HIV and leprosy are reported. One had developed borderline lepromatous leprosy one year after identifying HIV infection, while the other two had indeterminate leprosy and both conditions were identified at the same time in these two patients. All three cases showed satisfactory response to standard antileprosy multidrug therapy.

Four cases of HIV infection in children between one to eight years of age are reported. Three were males and the other one female. One child was horn to known HIV infected mother. The female child was victim of sexual abuse and had disseminated tuberculosis with syphilis and gonorrhoea. Other two children were having systemic as well as dermatological disorders for which HIV test was done and found positive.

Five hundred twenty seven HIV seropositive male cases were observed for herpes zoster for a period of five years. Overall incidence of herpes zoster in HIV infection was found to be 11.8%. Herpes zoster was presenting symptom in 50% cases. It developed in first year of follow up in 38.8% cases, in second and third year of follow up in 4.8% cases each and in fourth year in 1.6% case. Majority of cases (89%) were in age group of 20 - 40 years. Thoracic dermatome (68%) was commonest to get involved followed by cervical (14.5%), trigeminal (9.7%) and lumbosacral (8%). Among other associations of HIV seropositive herpes zoster cases 24.2% cases had tuberculosis and 4.8% cases had hepatitis B virus infection. The skin lesions of herpes zoster in majority of cases were bullous, haemorrhagic and necrotic.

Forty six cases of chronic liver disorders with and without cutaneous manifestations were studied for abnormalities of liver function tests. 27 cases were associated with cutaneous manifestations and 19 cases without cutaneous manifestations. A higher serum bilirubin level was seen in all cases with cutaneous manifestations. Serum bilirubin was significantly high (P<0.05) in patients of chronic active hepatitis with cutaneous manifestations. Serum alkaline phosphatase and serum glutamic pyruvic transaminase (SGPT) levels were significantly high in chronic active hepatitis and alcoholic liver disease without cutaneous manifestations respectively.

Pyoderma gangrenosum (PG) has previously been reported in very few patients with HIV infection. We describe here a 30-year-old housewife with HIV infection having multiple ulcerations over lower limbs characteristic of PG.

The pattern of skin disorders among 11393 civil and 8123 defence service personnel who attended out-patient department (OPD) from January 1989 to December 1994 is presented. Infective dermatoses were more common in civil population (41.2%) as compared to defence service personnel (36.3%). Fungal infection was common in both groups (15.1% and 17.2%) whereas parasitic infestations and pyoderma were more common in civil population (12.8% and 6.1%) as compared to service personnel (7.8% and 3.6%). Among non-infective dermatoses eczemas were more common in civil population (17.3%) as compared to Armed Forces personnel (11.7%), whereas papulosquamous disorders, pigmentary disorders, acne and alopecia were more common in Armed Forces personnel (13.5%, 13.4% 8.7% and 6.2%) as compared to civil population (10.8%, 10.1%, 6.4% and 4.1%). The incidence of other skin disorders did not differ much between the two groups.

Blood groups in 104 cases of HIV infection and 300 normal persons were determined. A relatively increased incidence of HIV infection was observed in persons with blood group O and relativey lower incidence in blood group B. Incidence of HIV infection was also low in Rh negative subjects. These results suggest a possible relationship between the incidence of blood group and the natural defence mechanism against HIV infection.

One hundred twenty histologically confirmed cases of leprosy having macular lesions were evaluated clinically and histopathologically according to Ridley-Jopling classification. Of these 120 cases, the majority (91 or 75.8%) were young adults. The main clinical findings were: a single macule in 42 patients (35%), multiple macules 2-5 in numbers in 35 patients (29.1%), 6-10 macules in 17 patients (14.1%) and more than 10 macules in 26 patients (21.6%). Impairment of sensation over the macular lesions was present in 62 cases (51.6%), total loss of sensation was noticed in 31 patients (25.8%) and sensation was intact in 27 patients (22.5%). Acid-fast bacilli were detected in 11 cases (9.1%) by slit-skin smear examination. Clinical examination of the 120 cases revealed features of TT in 16 (13.3%), BT in 41 (34.1%), BB in 11 (9.1%), BL in 13 (10.8%), LL in 7 (5.8%) and indeterminate leprosy (IL) in 32 patients (26.6%). On the contrary, histologically there were 22 cases of TT (18.3%), 38 cases of BT (31.6%), 8 (6.5%) BB, 10 BL (8.3%), 7 LL (5.8%) and 35 cases of IL (29.1%). Histopathological features were consistent with the clinical picture in 84 patients (70%).

A case of tuberculosis verrucosa cutis in an unusual site is being reported. The patient had presented with recurrence of a perianal growth which had been excised in the past. A histopathological study done during the recurrence confirmed tuberculosis. The patient's chest X-ray showed pulmonary tuberculosis, though he had no chest symptoms and sign. He responded favourably to anti-tubercular treatment.