Phacomatosis cesioflammea with Klippel Trenaunay syndrome: A rare association.

A 30-year-old Indian male presented with bilateral Nevus of Ota, extensive nevus flammeus over the trunk and left lower limb with soft tissue hypertrophy and varicosities affecting the left lower limb. He was otherwise in good general health. A diagnosis of Phacomatosis cesioflammea or Phacomatosis pigmentovasularis Type II with Klippel Trenaunay syndrome was made. The case is being reported on account of its rarity.

Terminal 4q deletion syndrome.

Terminal deletion of the long arm of chromosome 4, (4q) is a rare event. It is characterized by spectral phenotypic manifestations, depending upon the site and quantity of chromatin lost. The chromosomal loss which span 4 (q31-q35) segment often manifests as craniofacial anomalies, mental retardation with ocular, cardiac, genitourinary defects and pelvic/limb dysmorphism. These abnormalities are usually unilateral. We report a female child (46, XX), aged 11 months, born to nonconsanguineous parents, bearing chromosomal deletion of 4 (q31.2-35.2) segment, which has manifested as craniofacial hypoplasia of left side of face, ipsilateral ptosis, erythroderma and bilateral thumb anomalies.

Kaposi's sarcoma as a presenting manifestation of HIV.

Kaposi's sarcoma is a multi-focal vascular tumor involving skin and the other organs. HIV associated Kaposi's sarcoma is one of the AIDS defining condition. It is rarely reported from India. We report a 40-year-old heterosexual married male with widespread cutaneous lesions of Kaposi's sarcoma without any oral lesions or systemic association as a presenting manifestation of HIV.

Histopathological manifestations in kidney of Clarias batrachus induced by experimental Procamallanus infection.

Kidney of Clarias batrachus infected with Procamallanus showed varying degrees of histopathological alterations on 15, 30, 45 and 60 days post-infection. The infected kidney showed variable sized glomeruli, cloudy swelling in tubules, vacuolar/atrophic degeneration, fibrosis, mild degenerative changes in distal convoluted tubules, enlarged Bowmen's capsule, necrotic changes as well as increased granulation and hyperplasia in proximal convoluted tubules after 15 days. After 30 days of infection, the changes were rupture of Bowmen's capsule wall, degenerative changes, edema, necrosis, pyknosis, karyorrhexis and karyolysis in proximal and distal convoluted tubules, fibrosis, cloudy swelling and inflammatory lymphocytes, proliferation and shrinkage in glomeruli, and vacuolization in proximal convoluted tubules as well as cloudy swelling. After 45 days, the infected kidney showed cloudy swelling in glomeruli as well as variation in their size, infiltration of RBCs in intralobular vein and necrosis in proximal convoluted tubules, cloudy swelling in interstitium, vacuolization in the epithelial lining cells, necrosis in haemopoietic tissue and inflammatory edema. After 60 days post-infection, the changes were rupture of intralobular vein, cloudy swelling, necrosis in few proximal convoluted tubules, atrophy and shrinkage in glomeruli, distinct inflammatory edema, pyknosis, karyorrhexis and karyolysis, aggregation of lymphocytes and dilation in blood vessels.

Drug donations to developing countries.

Developing countries often receive donations of drugs either during acute emergencies or as part of long-term development aid. The donations may come from corporate bodies or governments. Unfortunately, there have been many examples of drug donations that cause problems instead of being helpful. Very often an emotional appeal for massive medical assistance is issued without determining the priority needs. The main problems are addressed in this paper.

Drug donations to developing countries.

PIP: Developing countries often receive donations of drugs from corporations and governments during acute emergencies or as part of long-term development aid. However, donated drugs are often not relevant to the circumstances in the receiving country, many drugs arrive unsorted and under trade names with no international non-proprietary name, they may arrive in the wrong quantities, the quality of donated drugs does not always comply with donor countries' standards, and they often arrive without adequate package inserts or production information, and sometimes under a brand name unfamiliar in the recipient country. Local doctors often do not know how to use the drugs since they are not usually available in their country. The level and quality of communication between donors and recipients must be improved, and recipients advised on how they should specify the kind of help they need. Drug donations should benefit recipients as much as possible and be based upon receiving countries' expressed needs. Furthermore, only drugs of acceptable quality should be donated to other countries, no drugs should be donated which have been issued to patients or doctors and then returned to pharmacies for disposal, and after arriving in the recipient country, all drugs should have a remaining shelf-life of at least 1 year. In the acute phase of an emergency, it is better to send a standardized kit of drugs specifically designed for that purpose. Once the acute phase of an emergency ends, a donation in cash for the local or regional purchase of medical supplies will be more welcome than additional donations.^ieng

Prescribing policy for antimalarials.

PIP: It has been national policy in Malawi since the late 1970s and early 1980s for physicians to assume that an adult who presents with a history of fever and no obvious sites of infection has malaria. However, presumptive diagnosis of malaria may result in the unnecessary prescribing of antimalarials. Large numbers of prescriptions for antimalarial drugs led Queen Elizabeth Hospital's chief pharmacist to change local prescribing policy in July 1996. Since the malaria parasite (MP) test is routinely available to patients at the hospital, it was suggested that if patients were clinically suspected of having malaria, antimalarials would be dispersed only after laboratory confirmation. All 3650 patients attending the adult outpatient department suspected of having malaria on presumptive diagnosis were screened in a study conducted to determine how the new policy was being implemented and how many patients tested for malaria were truly parasitemic. The new approach reduced the total number of antimalarial prescriptions by 68%. The diagnosis of malaria on a presumptive basis is a method of low specificity which should be confirmed by microscopy before drugs are prescribed.^ieng

Terbinafine in the treatment of cutaneous leishmaniasis: a pilot study.

Twenty-seven patients were randomly picked for an open pilot study using terbinafine with a dose range of 250-500 mg/day for 4 weeks. The inclusion criteria were as follows: (1) the patient had to be aged 5 years or older; (2) the patient could be of either sex; (3) any number or location of the lesions was allowed; (4) parasitologic confirmation was required; (5) the patient was allowed no previous treatment; (6) pregnant or lactating patients were excluded; (7) informed consent from the patient or his/her parents was required. The parasitologic diagnosis was carried out by a slit smear technique followed by a Giemsa stain for parasite identification. Terbinafine was given in two different doses to two groups sorted according to age. The groups were as follows: Group 1, 5-15 years, 125 mg orally twice daily for 4 weeks: Group 2, > 15 years, 250 mg orally twice daily for 4 weeks. Laboratory blood investigations including complete blood count, creatinine, urea, and liver function tests were carried out initially and at 2 weeks and 4 weeks. Clinical response was evaluated by assessing the per cent of improvement of erythema, induration, and ulceration at 2 weeks and at 4 weeks after admission. The final assessment was reported at 4 weeks: complete cure, 100% improvement with no relapse; partial cure, > or = 60% improvement; failure, < 60% improvement. Overall clinical response included patients with both complete and partial cure. Follow-up for patients with complete cure was carried out monthly for 6 months to assess the relapse rate. Patients with partial cure or failure were switched to sodium stibogluconate intralesionally.

Darier-White disease in a Saudi patient associated with systemic involvement.

A 22 year-old Saudi patient is reported who had Darier-White disease (Keratosis follicularis), presenting with the classical cutaneous manifestation of this disease in addition to systemic symptoms, including chronic renal failure, mental retardation, epilepsy, cataract and corneal opacities.

A case of angiolymphoid hyperplasia with eosinophils.

The authors report a case of angiolymphoid hyperplasia with eosinophils in a 45-year-old Syrian man working in Saudi Arabia. His skin lesions recurred eighteen months after they were surgically excised.

Cutaneous leishmaniasis: schedules for intralesional treatment with sodium stibogluconate.

BACKGROUND: Various therapeutic modalities have been used for treating cutaneous leishmaniasis. Intralesional pentavalent antimonial injection is one of the effective therapeutic modalities. In this study, the efficacy of three different intralesional schedules with sodium stibogluconate have been investigated. METHODS: Ninety-six patients with 129 lesions were entered into the study, all with confirmed diagnosis of cutaneous leishmaniasis. The lesions were treated with three different schedules, including daily, alternate day, and weekly interlesional injections of sodium stibogluconate. The clinical response was then compared to arrive at the most effective schedule. RESULTS: The clinical responses (complete and partial cure) were 67%, 97%, and 91% for the daily, alternate-day, and weekly schedules, respectively. Lesions with either partial cure or failure of treatment were injected weekly with the same medication until complete cure had been achieved. The final overall success rate of complete cure was 99.2%. CONCLUSIONS: Alternate day or weekly intralesional treatment of cutaneous leishmaniasis with sodium stibogluconate are more effective than daily treatments.

The pattern of skin diseases in Asir region, Saudi Arabia: A 12-month prospective study in a referral hospital.

The literature on the pattern of skin diseases in Saudi Arabia is scanty. We have attempted to analyze the pattern of skin diseases seen in the dermatology unit of Asir Central Hospital, Abha, Southern Saudi Arabia, during a 12-month period from March 1992 to March 1993. All new patients who were seen for dematological complaints in the skin clinics, emergency room or in the wards were studied prospectively. A total of 1285 dermatoses were diagnosed in 1223 patients during the 12-month study period. Out of the top 12 groups diseases, eczema/dermatitis (25.68%) came first, followed by viral infections. Among the eczema group, atopic eczema accounted for 53.64% and was most frequently observed in children (110/177 or 62.14%) compared to adults. The main causes of superficial mycoses were dermatophytosis and candidiasis. Psoriasis was the most common papulosquamous disorder. Scabies was seen in expatriate Egyptians and Asiatics only. Primary pyogenic infections of the skin were uncommon. The pattern of skin diseases in Saudi Arabia shows a predominance of eczema. Viral infections and dermatophytosis are the most common infective dermatoses, while pyogenic infections are relatively uncommon.

Cardiac changes in acute viral hepatitis in Varanasi (India): case reports.

Three cases of acute viral hepatitis are reported with various cardiac changes such as transient left ventricular hypertrophy, myocarditis and progressive cardiomegaly (cardiomyopathy). Extra-hepatic manifestations of acute viral hepatitis are rare but have been well documented. The aims of the present study are to highlight the cardiac involvement in acute viral hepatitis and to report the clinical implications of cardiac changes in acute viral hepatitis.