Development and validation of a Hindi language health-related quality of life questionnaire for melasma in Indian patients.

Background: Melasma, which is fairly common in Indians, causes signifi cant emotional and psychological impact. A Hindi instrument would be useful to assess the impact of melasma on the quality of life in Indian patients. Objective: To create a semantic equivalent of the original MELASQOL questionnaire in Hindi and validate it. Methods: A Hindi adaptation of the original MELASQOL (Hi-MELASQOL) was prepared using previously established guidelines. After pre-testing, the Hi-MELASQOL questionnaire was administered to 100 women with melasma visiting the out-patient registration counter of Safdarjung Hospital, Delhi. These women were also administered a Hindi equivalent of the Health Related Quality of Life (HRQOL) questionnaire. Melasma area severity index (MASI) of all the participants was calculated. Results: The mean MASI score was 20.0 ± 7.5 and Hi-MELASQOL score was 37.19 ± 18.15; both were highly, positively and signifi cantly correlated. Reliability analysis showed satisfactory results. Physical health, emotional well-being and social life were the most adversely affected life domains. Limitations: It was a single-center study and the number of patients studied could have been larger. Conclusion: Hi-MELASQOL is a reliable and validated tool to measure the quality of life in Indians with melasma.

Inferior turbinate osteoma: a case report.

Osteoma is the most common benign tumor of the paranasal sinuses. Turbinate osteomas are very rare and only five middle turbinate, two inferior turbinate and one superior turbinate osteoma cases have been reported. We present a rare case of osteoma of the left inferior turbinate in a patient presented with unilateral nasal obstruction that was removed endoscopically and conduct a literature review on turbinate osteomas arising from differen t turbinates.

Pulmonary blastomycosis on autopsy: a rare case report.

A case of pulmonary blastomycosis on autopsy in a middle aged male from rural background is presented herewith. Blastomycosis is a pyogranulomatous disease caused by the dimorphic fungus blastomyces dermatitidis. Blastomycosis is endemic in regions of North America that border the Great Lakes. It is one of the great mimickers in medicine. Pulmonary blastomycosis has a broad range of clinical presentations, varying from completely asymptomatic pulmonary infiltrates to diffuse and massive parenchymal involvement that can lead to Acute Respiratory Distress Syndrome (ARDS). Human infection occurs when soil containing microfoci of mycelia is distributed and airborne conidia are inhaled. If natural defences in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad- based bud. Most of the cases of blastomycosis reported in India are imported from the endemic areas of the World except a few authochthonous cases in North India.

Monthly rifampicin, ofloxacin, and minocycline therapy for generalized and localized granuloma annulare.

Background: The localized form of granuloma annulare is usually self‑limiting, resolving within 2 years. Generalized granuloma annulare, on the other hand, runs a protracted course, with spontaneous resolution being rare. It is also characterized by a later age of onset, an increased incidence of diabetes mellitus, poor response to therapy, and an increased prevalence of HLA Bw35. Objective: To assess the efficacy of monthly pulsed rifampicin, ofloxacin, and minocycline (ROM) therapy in the management of granuloma annulare.Methods: Six biopsy proven patients of granuloma annulare were included in the study, five of the generalized variety, and one localized. Three of these patients were resistant to standard modalities of treatment. All six patients were treated with pulses of once monthly ROM till complete resolution of all lesions. Results were analyzed in terms of complete resolution of lesions and side effects. Presence of comorbid conditions was noted. Result: All six patients were successfully treated with 4-8 pulses of monthly ROM. None of the patients reported any adverse effects. Limitations: Small sample size and the lack of a control group are limitations. Conclusion: Treatment with pulses of once monthly ROM caused complete resolution of lesions in both localized and generalized granuloma annulare, even in cases recalcitrant to conventional therapy. There were no side effects in any of the patients. Larger trials are needed to substantiate the efficacy of monthly ROM in granuloma annulare.

Correlation of gallstone characteristics with mucosal changes in gall bladder.

Background and aim: Gallstones are known to produce diverse histopathological changes in the gall bladder. Our aim was to correlate various gallstone characteristics (number, size, weight, volume and morphological type) with the type of mucosal response in gall bladder (inflammation, hyperplasia, metaplasia and carcinoma). Methods: The study was conducted on 330 open cholecystectomy specimens with complete gallstones. The stones were assessed for various parameters i.e. number, size, weight, volume and morphological type. For microscopy, sections were obtained from the fundus, body and neck of the gallbladder. Additional sections were taken from abnormal looking areas. Results: Out of the 330 cases, 194 (59%) had mixed stones, 84 (25%) combined, 30 (9%) pigment and 22 (7%) had cholesterol stones. Number of stones varied from a single calculus in 131 (39.6%) cases, double in 29 (8.8%) and multiple in the remaining 170 (51.6%) cases. Cholecystitis, hyperplasia, metaplasia and carcinoma were more commonly seen with mixed and multiple stones. The average weight of calculi in cholecystitis was 2.551 gm, in hyperplasia 3.619 gm, metaplasia 4.549 gm and 17.96 gm in cases with carcinoma. Similarly, average volume of the stone(s) was 2.664 ml in cholecystitis, 3.742 ml in hyperplasia, 4.532 ml in metaplasia and 19.178 ml in carcinoma. The average calculus size (2.147 cm) was found to be maximum in cases with carcinoma, followed by hyperplasia (1.187 cm), metaplasia (1.145 cm) and cholecystitis (1.136 cm). Conclusion: As the weight, volume and size of the stone increases the changes in the gall bladder mucosa changes from cholecystitis, hyperplasia, metaplasia, dysplasia, to carcinoma.