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Pityriasis rosea, is an acute self-limiting papulosquamous inflammatory disorder. It usually starts with a herald patch on the trunk and proximal extremities, followed by scaly oval patches that give them a “Christmas tree” appearance. The lesions may be associated with fever a rash. The disease can present as numerous morphologies such as papular, urticarial, lichenoid, and generalized that may be confused with other conditions such as secondary syphilis, seborrheic dermatitis, nummular eczema, pityriasis lichenoides chronica, tinea corporis, viral exanthems, lichen planus, and PR like eruption linked to particular drugs. We report a rare case of polymorphic pityriasis rosea in paediatric age group.

Background: Connective tissue diseases (CTDs) are chronic in nature and carry a high risk of morbidity, disability, and mortality if not recognized and treated promptly. Data on clinical spectrum of CTDs in the pediatric age group are sparse from developing countries such as India. Objective: To study the clinicoepidemiological spectrum of CTDs in the pediatric age group. Methodology: A hospital-based, cross-sectional, observational study was undertaken over a period of 16 months from January 2021 to June 2022 in the dermatology outpatient department and pediatric rheumatology clinic in a tertiary care hospital in North India. Clinical and laboratory findings were recorded. Results: A total of 100 children diagnosed with a CTD were included in the study. The mean age was 11.11 ± 4.20 years. Out of 100 children, 55% were female and 45% were male with a male-to-female ratio of 1:1.2. Our study included 63% juvenile idiopathic arthritis, 17% systemic lupus erythematosus, 7% juvenile dermatomyositis, 6% Kawasaki disease, 3% systemic sclerosis, and 2% Henoch–Schonlein purpura and mixed CTD patients each. Mucocutaneous features commonly seen were rash (40%), oral ulcers (22%), and photosensitivity (18%). Commonly seen systemic features were joint pain (77%), followed by fever (63%). Conclusion: Mucocutaneous manifestations are frequently seen in CTDs and constitute a frequent and an early manifestation of CTD. Early recognition of CTD in the pediatric age group will help in timely initiation of treatment to prevent disabilities and mortality.

Background Vulvovaginal candidiasis (VVC) is a prevalent form of vaginitis, and most patients show improvement when treated with antifungal medications. However, recurrence may affect a minority. It has been found through previous research that the concomitant utilisation of probiotics during acute VVC leads to early relief of symptoms and signs and offers a preventive measure against recurrences. Objectives This study aimed to assess the efficacy of the combination of oral probiotics with conventional antifungal treatment as compared to conventional antifungal treatment alone. Methods Sixty patients who were newly diagnosed with VVC were enrolled in a randomised controlled trial. They were divided into two groups. Group A included 30 cases treated with conventional antifungal medication (oral fluconazole 150 mg single dose), while Group B included 30 cases treated with conventional antifungal medication (oral fluconazole 150 mg single dose) alongside oral probiotic capsules (Lactobacillus rhamnosus, L. crispatus, L. gasseri, L. jensenii) for 2 months. The clinical and mycological findings were recorded before and after treatment. The relapse rate and side effects were recorded during the period of our study. Results No significant difference between the clinical cure rate, mycological cure, and relapse rate was seen between the two groups. (P < 0.05). However, a larger proportion of patients in Group B (97%) achieved complete remission compared to Group A (90%). No side effects were noted in either of the groups. Conclusion Based on the findings, it can be concluded that the addition of probiotics to conventional antifungal treatment led to better rates of clinical and mycological cure and a lower likelihood of relapse compared to conventional antifungal treatment alone.

Background: Psoriasis is a chronic, immune mediated inflammatory condition of the skin and imbalance in inflammatory mediators could result in insulin resistance, metabolic syndrome and facilitate the occurrence and progression of Non-alcoholic fatty liver disease (NAFLD). Objectives: Primary objectives: To study the frequency of NAFLD in cases of chronic plaque psoriasis and controlsTo study the interleukin levels in cases of chronic plaque psoriasis and controls. Secondary objectives: To study the BMI, lipid profile, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin in cases and controlsTo study the association of age, duration of psoriasis, PASI (psoriasis area severity index), BSA (body surface area) involved, BMI (body mass index), lipid profile, obesity, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin levels with NAFLD in patients of chronic plaque psoriasisTo correlate serum levels of IL1-β, IL6 and TNF-α with NAFLD in patients of chronic plaque psoriasis. Methods: 50 clinically diagnosed cases of chronic plaque psoriasis with age ≥ 18years, diseases duration ≥ 6 months and 30 age and sex matched controls were recruited. PASI, BSA of cases was calculated and BMI, BP, WC of all subjects was measured. Serum lipid profile, FBS, PPBS, insulin level, IL1- β, IL6, TNF- α, high frequency B-mode ultrasound, LFT and fibroscan were done in all subjects. Results: 28(56.0%) cases and 2(6.6%) controls had NAFLD with statistically significant difference. Significantly elevated WC, serum insulin, deranged lipid profile, fatty liver, transaminitis, fibroscan score, liver fibrosis, NAFLD and interleukins were found in cases vs controls. There was a significant association of NAFLD in psoriatic patients with increasing duration of psoriasis, BMI ≥23 Kg/m2, high WC, increasing BSA involved, deranged lipid profile, raised total cholesterol levels and increasing number of risk factors. Nonsignificant but positive association of NAFLD in cases was found with high levels of IL1 – β, IL – 6, TNF-α, FBS and increasing PASI. Conclusion: Significantly increased interleukin levels and their weak positive correlation with the severity of psoriasis (PASI, BSA) in patients of chronic plaque psoriasis explains the possible role of inflammation in the causation of psoriasis. Screening may be considered in psoriatic patients with increasing duration of psoriasis, high WC, high BSA involved, high BMI, obesity, dyslipidemia and insulin resistance. Limitations: Small sample size. Conflict of Intrest: NONE.

Granulomatous vulvitis (GV) is an idiopathic entity typically presenting with chronic, painless swelling of the genitals with histologic evidence of granulomatous inflammation. Granulomatous vulvitis can typically start as an acute inflammatory condition, which gradually transforms into a chronic disease with a relapsing and remitting course leading to swollen, indurated, and distorted external genitalia. Association of GV with Crohn's disease is being increasingly recognized. However, the association of GV with ulcerative colitis is unreported. Here, we report a rare case of GV in a middle-aged Indian female with characteristic gastrointestinal involvement suggestive of ulcerative colitis. We hope to contribute to an earlier recognition and a better management of the vulvar and gastrointestinal lesions of ulcerative colitis.

Abstract Background With the pace of urbanization, symptoms of loneliness emerge as one of the most devastating mental illnesses among city dwellers in the modern age. The present study has tried to identify the potential factors and correlates which affect loneliness vulnerability. Methods The data for this study were collected from three different areas of Mumbai (i.e., Dadar, Bandra, and Chembur).This study was conducted through a cross-sectional household survey of household heads in the five different housing typologies/ localities between January and June 2016.A total of 450 household data were collected using the quota sampling method. Loneliness was the main dependent variable. The bivariate analysis was used to see the percentage of loneliness among respondents. Bivariate analysis for categorical data was carried out using the chi-square (χ2) test. Logistic regression analysis was performed to explore the correlates of loneliness among household heads. The probability of significance was set at 5%. Results It was found that around 7 percent of respondents often feel lonely, and 21 percent of respondents sometimes feel lonely in the last seven days preceding the survey date. Household heads with two or more chronic diseases had higher odds (OR = 4.87, CI = 1.52–15.57) of loneliness than household heads without any chronic disease. The odds of loneliness were almost 3 times higher (OR = 3.05; CI = 1.11–8.38) among females as compared to males. Household heads living alone (single) had higher odds (OR = 19.99; CI = 4.14–96.59) to suffer from loneliness than those living in a joint family. Conclusion Finding reveals that level of loneliness symptomatology in urban dwellers may be attributed significantly by individual (i.e., morbidity status and sex of respondent), social (i.e., personal relation) and residing locality characteristics. Community psychological intervention along with enhanced civic engagement can reduce level of loneliness in existing slum rehabilitees.

Background: Mastocytosis is a heterogeneous group of disorders that is characterized by excessive proliferation and pathologic accumulation of mast cells in various body tissues. The mast cells also have abnormal morphology and aberrant expression of surface receptors. Clinical Description: A 4-year-old boy was brought with a history of generalized skin lesions since birth and abdominal distension for 3 years. The diagnosis had not been established to date. General physical examination revealed severe acute malnutrition, pallor, dental staining, facial hypertrichosis, polymorphous skin lesions (cicatricial alopecia, diffuse erythema, multiple plaques of variable diameter, skin-colored nodules, and hypertrophic irregular scars), and positive Darier's sign. He also had hepatosplenomegaly. The differentials considered were congenital erythropoietic porphyria, systemic mastocytosis (SM), multifocal Langerhans cell histiocytosis, and linear immunoglobulin A bullous dermatosis. The presence of mast cells on skin biopsy and elevated serum tryptase levels led us to suspect SM and perform bone marrow studies. The diagnosis of “aggressive” SM was initially made on the application of the diagnostic criteria but revised to “smoldering” SM with the emergence of Vitamin B12 deficiency as the probable cause of pancytopenia. Management: Management was planned by a multidisciplinary team: pediatrician, dermatologist, and hematopathologist. The parents were counseled about the nature, natural history, treatment options, and prognosis of the disorder. The child was provided with nutritional rehabilitation and medication for the cutaneous symptoms (selective histamine H1 receptor inverse agonist, H2-receptor antagonist, and application of topical tacrolimus and calamine lotion). Conclusion: The prognosis varies according to subtype. Careful correlation of clinical and laboratory investigations is required when applying the diagnostic criteria for staging.

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent follicular disorder affecting apocrine gland bearing areas such as axillae, inframammary area and groin. Significant association of HS with metabolic derangements such as hypertension, obesity, hyperlipidemia and hyperinsulinemia has been found. There is dearth of literature on epidemiological and metabolic profile of HS in Indian subjects. Aim: The aim of this study is to assess abnormalities in the levels of fasting blood glucose, serum insulin, and lipid profile in patients with HS. Primary Objective: To assess the frequency of abnormal levels of fasting blood sugar, serum insulin and lipid profile in patients with HS. Secondary objectives: To assess the frequency of hypertension, raised basal metabolic index, polycystic ovarian syndrome, follicular disorder, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) in patients with HS and to assess the severity of of clinical presentation HS using Hurley staging system. Methodology: This is a retrospective record based study. Records of clinically diagnosed patients of HS, aged > 18 years fulfilling the inclusion and exclusion criteria were analysed. Results: Total 30 patients were recruited with 1:1 male to female ratio. Five (16.67%) cases fulfilled NCEP ATP III criteria for the diagnosis of metabolic syndrome. Statistically significant association was observed between severity of HS, in younger age group (

Abstract Background Mining industries have enormous potential to improve food shortage by providing employment opportunities in its mining vicinity. But, simultaneously, these areas also suffer from ‘resource curse’ due to detrimental effects of mining. Hence, this study examined the effects of coal mining on household food availability and food access among proximate population residing in resource-rich but economically backward mining region of Dhanbad district, Jharkhand, India. The primary data was collected from two compare groups, viz. households from exposed versus non-exposed villages of mining effect under the cross-sectional research design using structured questionnaire between September, 2014, and February, 2015. Both bivariate and multivariate statistics were used to assess the study objectives. Results Finding shows that households from non-mines affected villages were at 40% higher risk of food shortage than household from mines affected villages. Furthermore, odds ratio shows that rise in percentage of expenditure on food also increases the food shortage vulnerability. Female-headed households, below poverty line households and MNREGA card holders households were significantly positively related to food shortage. In contrast, households with membership of any socio-political organization and more than 2 acres of farmland were significant negatively associated with food shortage. Procurement of food on credit from ration shops was found to be a predominant strategies to cope with food shortage, followed by borrowing food from neighbours and relatives. Conclusion In nutshell, the study shows that households from non-mines affected villages were at high risk of food shortage. However, percentage expenditure on food indicator reveals that household from mines affected villages was comparatively more vulnerable to food shortage than its counterpart. The membership of any socio-political organization emerges as a main factor which reduces the risk of food shortage.