Correlation of Clinico-pathological Classification of Hansen's Disease in a South Indian City.

Hansen's Disease (HD) presents itself in different forms depending on the individual's immune status, and based on this Ridley-Jopling classified the disease into five sub-groups. The aim of this study was to evaluate the role of histopathology and bacteriological index (BI) in accurate staging of HD with clinical correlation. Fifty HD patients with clinical diagnosis confirmed by histopathology were included. Patients in reaction and on treatment were excluded. Case records and histopathological slides were viewed and BI was recorded. In 10/50 cases, a diagnosis of HD was made or suspected, but were not clinically classified. In these, histopathology proved useful in diagnosis and classification. Indeterminate HD was the most common histopathological diagnosis (6 cases). The remaining 40 patients, were clinically classified using the Ridley-Jopling classification, as Indeterminate Leprosy (IL) in 10/40 (25%), Tuberculoid Leprosy (TT) 5/40 (12.5%), Borderline Tuberculoid (BT) 16/40 (40%), Borderline Lepromatous (BL) 4/40 (10%) and Lepromatous Leprosy (LL) 5 (12.5%). HD was common in males with male to female ratio of 1.66:1 and affected the younger individuals (maximum in 21 to 30 years). On histopathology BT was the most common type (40%) followed by IL (27.5%), BL (12.5%), TT (10%) and LL (10%). No case of Mid-Borderline (BB) type was diagnosed clinically or histopathologically. Overall concordance between clinical and histopathological diagnosis was 65% (26/40 cases) and for each type was IL = 80%, TT = 20%, BT = 75%, BL = 50% and LL = 60%. Where classification seemed difficult as in cases of BT and BL, II played an important role. The overall concordance between clinical classification and histopathological diagnosis of DO is 65% in this study. Th *discordance that is observed is between BT and TT, the paucibacillary type and BL andILL the multibacillary type and hence the treatment is not affected. Overall, IL was a common diagnosis on histopathology in this study'(11/40 cases and 6/10 cases). If clinically warranted, a repeat deeper punch of skin biopsyrmay be required for a proper categorization of the cases.

Factors affecting the nasal carriage of methicillin-resistant Staphylococcus aureus in human immunodeficiency virus-infected patients.

Human immunodeficiency virus-infected patients attending skin outpatient department were studied for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and associated factors affecting nasal colonization. Nasal swabs were used for isolation of S. aureus. MRSA were detected by agar screen and agar dilution methods. Careful examination for dermatoses was carried out. Forty-six of the 60 (76.67%) outpatients with HIV infection were colonized with S. aureus in the anterior nares. Significant number of S. aureus carriers were in the 31-40 year age group. Methicillin resistance was found in eight (17.39%) isolates. Of the 46 S. aureus strains, 29 (63%) were resistant to erythromycin, 69.5% to co-trimoxazole and 41.3% to ciprofloxacin. Co-trimoxazole use was found to be a risk factor for S. aureus carriage ( P = 0.0214) but not for methicillin resistance. Hospital stay for more than 10 days was a risk factor for methicillin resistance whereas stay for more than 25 days was found to be a highly significant risk factor. Dermatophytosis and herpes simplex virus infection were other risk factors for nasal carriage of S. aureus.

Molluscum contagiosum-like lesions in lepromatous leprosy.

A 23-year old male presented with multiple, asymptomatic, raised lesions of 4 months' duration. The lesions were well demarcated. Dome-shaped papules and nodules were seen on normal looking skin; some were shiny, pearly white and umbilicated. Bilateral greater auricular, ulnar, radial cutaneous and lateral popliteal nerves were thickened. Slit skin smear from an umbilicated nodule had a BI of 6+. Biopsy showed features of lepromatous leprosy.

Pattern of dermatoses among inmates of district prison--Mangalore.

The present paper studies the pattern of dermatoses among 225 inmates of a jail, over a period of 6 months (Feb- July' 99). 63.6% inmates screened had dermatoses. Among those with dermatoses 63.3% were infectious and 36.4% were non-infectious. Among the infections, fungal infections (51.3%) constituted the maximum. Pediculosis copitis was found in 6.6% of inmates. in the non-infectious group, pigmentary changes (21%) and dandruff (21%) were noted. Overcrowding prevalent in jail (73% excess inmates) could be contributory factor for the high incidence of infections.

Mycobacterium fortuitum endocarditis and meningitis after balloon mitral valvotomy.

Mycobacteria rarely cause endocardial infections. We describe the clinical course of a patient who developed endocarditis, and meningitis with Mycobacterium fortuitum following balloon mitral valvotomy. The patient was treated with amikacin and clarithromycin but did not respond. She developed haemolytic anaemia as the terminal event.

Effect of dialysis on psoriasis : A clinical study.

Twenty patients with extensive psoriasis of more than three years duration not responding to conventional medical treatment were studied to assess the effect of dialysis. Ten patients were subjected to haemodialysis and ten to peritoneal dialysis. Patients were periodically assessed regarding responses by standard critera. At the end of six months 4/8 (50%) in haemodialysis group and 6/10(60%) in peritoned dialysis group showed improvement. One patient in haemodialysis group developed exfoliative dermatitis eleven days after onset of dialysis. In this study though a beneficial effect in psoriasis was noted following dialysis, the effect was temporary.

K A P study on HIV / AIDS among first year MBBS students.

This Kap (Knowledge, Attitude, Practical) study was to assess the current level of knowledge among first year M.B.B.S. students about AIDS at the point of entry to medical course. One hundred and seventy-one students were given a pre-tested close ended questionnaire. Overall level of knowledge about AIDS was found to be 64.91%. Male students were found to have better knowledge regarding transmission and prevention of AIDS than female students. Misconceptions were found to exist regarding mode of transmission, prognosis and prevention. Awareness programmes should be initiated among M.B.B.S. students in the first year itself, so that, lacunae can be rectified.