Venous thromboembolism incidence in the Cooperative Study of Sickle Cell Disease.

BACKGROUND: Venous thromboembolism (VTE) has been recently recognized as a complication of sickle cell disease (SCD); however, the incidence of VTE in SCD is unknown. OBJECTIVES: The primary objective of this study was to determine the incidence of first VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), among SCD patients age ≥ 15 years. We also evaluated genotypic differences in VTE risk and determined the relationship between VTE and mortality. PATIENTS/METHODS: In this retrospective cohort study, we used data from the Cooperative Study of Sickle Cell Disease (CSSCD) to calculate incidence rates for first VTE. We used Cox proportional hazard models to estimate hazard ratios (HRs) for time to VTE by genotype and time to death by VTE status. RESULTS: We included 1523 SCD patients aged ≥ 15 years with 8862 years of follow-up in this analysis. The incidence rate for first VTE was 5.2 events/1000 person-years (95% confidence interval [CI] 3.8-6.9) with a cumulative incidence of 11.3% (95% CI 8.3-15.3) by age 40 years. Individuals with the SS/Sß(0) -thalassemia genotype had the highest rate of VTE (7.6 events/1000 person-years [95% CI 5.3-10.6]). The incidence of PE exceeded that of isolated DVT (3.6 [95% CI 2.5-5.1] events/1000 person-years vs. 1.6 [95% CI 0.9-2.7] events/1000 person-years), although this difference was not statistically significant. SCD patients with VTE had a higher mortality rate (adjusted HR 2.32 [95% CI 1.20-4.46]) than those without VTE. CONCLUSIONS: Patients with SCD are at substantial risk for VTE, and individuals with VTE are at higher risk of death than those without VTE.

Esthiomene resulting from cutaneous tuberculosis of external genitalia.

Tuberculosis of the external genitalia, which is rare, is usually secondary to pulmonary tuberculosis. Longstanding lupus vulgaris of the buttocks extending to the vulva and resulting in esthiomene is reported here. There was no evidence of tuberculosis of any other organ.

Comparative Efficacy of 20% Sodium Thiosulphate, 20% Miconazole and 1% Econazole in Pityriasis Versicolour and Persistence of Hypopigmentation and Following Treatment.

Fifty cases of pityriasis versicolor, confirmed mycologically, were each treated with either 20 % miconazole nitrate cream or 1% econazole nitrate cream. Patients were followed up at second, fourth and sixth weeks. Degree of repigmentation was noted and KOH preparation done at each to determine mycological cure. At the end of six weeks all the patients using all regimes were mycologically cured but only 30.4% showed complete repigmentation in the lesions.

Dermatophytosis in and Around Manipal.

Of the hundred cases clinically Diagnosed as dermatophytosis, -fungal elements were demonstrated by KOH Preparation in 52 cases and was isolated by culture in 42 cases. The most common age group involved was between 21 to 30 years. Crural region involvement was the most common among males, whereas waist involvement was more common among females. Trichophyton mentagrophytes (46.90%) and T. rubrum (31.9%) were isolated in most cases.

Puvasol Induced Lickenoid Eruption.

Generalized lichenoid eruption and transient rise in hepatic enzymes in a psoriatic treated with 8-methoxypsoralen and sunlight (PUVASOL) is reported.

Persistence of Psoralen Repigmentation in Vitiligo.

Though psoralens are successful in the treatment of vitiligo, especially in the coloured races, persistence of the repigmentation after stoppmg the drug has not en studied in detail. Opinion is, divided regarding the maintenance therapy. Among 16 vitiligo patients treated with oral psoralens, new lesions appeared in 6, though r6pigmentation obtained with these drugs remained stable. There was partial loss of repiginentation in 5 patients, complete loss in 2 complete loss and new lesions in one. Only two patients showed no change upto 2 years.

Holigarna Ferruginea Induced Allergic Contact Dermatitis.

Contact dermatitis due to Holigrana ferruginea Hook f-a member of the family Anacardiaceae, was seen in 4 patients. In three case,% the diagnosis was confirmed by patch tests. The presence of pyrocatechols in the acrid juice was detected by simple laboratory procedures. A DNCB-fike action of the purified extract is postulated.

Progeria.

A year old male child developed progeria manifesting most of the typical changes described in progeria. The boy also had extensive sclerodermatous changes in the skin.

Thickening of peripheral nerves in neurofibromatosis.

A rare case of multiple neurofibromatosis (von Recklinghausen's Disease) with bilateral, uniform and gross enlargement of peripheral nerves simulating nerve thickening in leprosy is reported. The case also showed characteristic palmar melanotic macules.

Fixed eruption due to rifampicin.

Cutaneous side effects due to Rifampicin are rare (less than 5%). We report an urticarial type of fixed eruption due to Rifampicin. Fixed eruption due to Rifampicin is not reported earlier.

Association of Nasal and Throat Staphylococci with Pyoderma Lesions.

A total of 109 cases of pyoderma were studied bacteriologicaliy by culture. Folliculitis cox~stituted the largest clinical group followed by impetigo and eczematoid dermatitis. Coagulase positive staphylococci were found to be the predominant aetiological agents in pure form and also in association with other infecting agents. Coagulase negative staphylococci constituted the next common organism, followed by beta-haemolytic streptococci. Nasal and throat swabs from all the cases were subjected to bacteriologic study and the association of nasal and throat staphylococci with pyoderma lesions was studied. Majority (56.66%) of staph-aureus strains were non typable; 56.66% of typable strains belonged to phage type III, 26.67% to phage type II and 16.67% to phage type I. The throat staphylococcal phage types were found to be associated more with pyoderma than nasal phage types.

Kyrle's Disease.

Three cases of Kyrle's disease are reported. AR the three cases showed lesions with typical morphology and histology. In one instance the disease was present in the earlier generation. An interesting feature is the observation of a Koebner- like phenomenon.

Acrodermatitis Enteropathica.

A case of acrodermatitis enteropathica (AE) without significant diarrhoea is reported. The response to oral zinc sulphate therapy in the case has been excellent.