Safety and efficacy of mifepristone versus dinoprostone gel in induction of labor: A randomized controlled trial.

AIM: The aim of this study was to evaluate the efficacy and safety of mifepristone for cervical ripening and induction of labor and compare the results with dinoprostone gel which is an established agent for labor induction. METHODS: A total of 100 patients were enrolled in a prospective study and assigned to one of two treatment protocols. After the exclusion of 10 patients, there were 46 patients in the mifepristone group and 44 in the dinoprostone group. Outcome was evaluated using the improvement in Bishop score, admission delivery interval, duration between induction and the onset of active phase of labor and the mode of delivery. RESULTS: The baseline demographics in the two groups were comparable. The improvement in Bishop's score at first post-intervention assessment was significantly better in dinoprostone group. Duration between instillation and active phase assessment was significantly lesser in dinoprostone group while the admission delivery interval was lesser in mifepristone group. There was no difference in mode of delivery between the two groups. CONCLUSION: The results of the study suggest that oral administration of 200 mg mifepristone in term patients is an effective method of labor induction; and is more convenient and equally safe as compared to intravaginal instillation of dinoprostone.

Harlequin syndrome: a mask of rare dysautonomic syndromes.

Harlequin syndrome (HS) is a rare disorder of the sympathetic nervous system which presents with unilateral decreased sweating and flushing of the face, neck, and chest in response to heat, exercise, or emotional factors. The contralateral side displays a compensatory overreaction to provide normal heat regulation of the face as a whole. In the literature, most of the cases are primary in nature and no underlying cause could be identified. Harlequin sign is used to denote these symptoms in patients who also exhibit associated oculosympathetic paresis, such as Horner syndrome, Adie syndrome, and Ross syndrome.We report a rare case of a 13-year-old boy who presented with complaints of flushing and sweating of the left side of the face after exertion, while the right side remained dry and maintained its normal color. No structural abnormality was identified on detailed work up. Thus, diagnosis of classic idiopathic HS was made. Despite the rarity of this syndrome, dermatologists should be acquainted with this distinctive entity and should refer the patient for complete ophthalmological and neurological examination.

Is sclerotherapy useful for cherry angiomas?

BACKGROUND: Sclerotherapy is a safe, effective, and easily available treatment modality, its role in cherry hemangioma is still unexplored. OBJECTIVE: This study aims at establishing the role and efficacy of sclerotherapy in treating cherry angiomas and its dermatological complications. MATERIALS AND METHODS: This prospective study included 20 patients with 100 lesions of cherry hemangiomas of size >0.2 mm. Intralesional injection of 0.1 mL of 3% sodium tetradecyl sulfate was used. Scarring, if any, was evaluated using "The Stony Brook Scar Evaluation Scale." Patients were called for weekly sessions for a maximum of 4 weeks. RESULTS: Of 100 lesions treated, 42 lesions responded with a single dose of sclerosant, 44 lesions required a second setting. Remaining lesions were injected for 3 weeks, of which 14 lesions did not remit completely and required a fourth sitting. Depending on response to sclerotherapy, patients were divided into 2 groups (Group A and Group B). On comparing these groups, no statistically significant (χ test) difference in the rate of healing was observed. CONCLUSION: Sclerotherapy with sodium tetradecyl sulfate 3% is effective in the treatment of cherry hemangiomas. It offers an economical alternative to other available conventional methods.

A rare pigmentary disorder in two non-identical siblings: Griscelli Syndrome -type 3.

Griscelli Syndrome (GS) is a rare autosomal recessive disorder characterized by pigmentary dilution of the hair and skin (partial albinism). Three different types (1-3) caused by mutation in three different genes have been described. Patients with GS type 1 have primary central nervous system dysfunction; type 2 patients commonly develop hemophagocytic lymphohistiocytosis and type 3 patients present with partial albinism only. Two siblings discussed here had silvery hair, eyebrows and eyelashes since birth with no features suggestive of immunodeficiency or neurological impairment, making it an even rarer presentation of Griscelli Syndrome, type 3. Diagnosis was confirmed on light microscopy (LM) of hair shafts. Both GS1 and GS2 have been described earlier. However, extensive search of the literature failed to reveal a similar presentation from Indian origin. This is the first ever report of GS-3 in non-identical siblings from India.

A rare manifestation of cysticercosis infestation.

There are many causes of urticaria, which may vary from infections to malignancy. Among the infections, infestations by cysticercosis (larval stage of the tapeworm called Taenia solium) is an important cause. The present report is of forty four years old female who presented with urticaria and swelling on face. The swelling was later diagnosed as cysticercosis by noninvasive ultrasonography. The urticaria subsided after the treatment of cysticercosis. We report this case for rarity of its presentation.

Membranous nephropathy: a rare renal manifestation of IgG4-related systemic disease.

This is a case of IgG4-related systemic disease (ISD) and its rare renal manifestation as membranous nephropathy (MGN). The patient presented with peripheral edema, hematuria and proteinuria. 24-h urine revealed proteinuria of up to 15 g/d. Renal biopsy revealed MGN and many IgG4-positive plasma cells. Serum IgG4 levels were elevated at 750 mg/dl (9 - 89 mg/d). Biopsies of multiple tissues revealed many IgG4-positive plasma cells. Prednisone was initiated after making the diagnosis of ISD. However, the patient progressed into renal failure and eventually needed dialysis despite rituximab therapy. The renal manifestation of ISD typically shows tubulointerstitial nephritis, but, rarely, it may include glomerular abnormalities such as MGN or membranoproliferative glomerulonephritis. Castleman disease (CD) and ISD share similarities in pathology, particularly in the lymph nodes. Rituximab has shown promising results in some patients with ISD, CD, and MGN, and its use should be considered in steroid-resistant cases. Clinicians need to be made aware of ISD and its varied presentations. Timely initiation of steroid therapy can induce remission, and delay in therapy can cause permanent organ damage. Therefore, clinicians must have a high index of suspicion to make an early diagnosis of ISD in order to initiate appropriate treatment.

Role of Psychological Assessment in Aesthetic Procedures.

The psychology behind an aesthetic procedure needs to be understood and assessed by the attending cosmetologist for the satisfactory outcome of the procedure. Being alert about certain psychiatric conditions can help in deferring certain procedures, which prevent us from correcting something that is actually not required and will protect us from future trouble. The incorporation of the user-friendly body dysmorphic disorder (BDD) screening questionnaire in preaesthetic procedure workup as a routine can help in excluding psychologically unstable patients, who can be a contraindication for conducting the procedure per se.

Venous Thromboembolism in Pregnancy and IVC Filter: A Case Report.

Introduction: Venous thromboembolism (VTE), composed of pulmonary embolism and deep venous thrombosis, can be a significant cause of morbidity and mortality during pregnancy. Underlying factors like thrombophillias can potentiate this risk many folds. Depending on these risks and peripartum stage, the benefits of thromboprophylaxis can outweigh potential side effects. Case Details: Hereby, we present case of a 35-year-old women with known case of Protein C and S deficiency with twin pregnancy who presented with chronic venous thrombosis followed by acute episode in proximal vessels of lower limb. So intervention in the form of inferior vena cava filter insertion has to be done to prevent dreaded complication in the form of pulmonary thrombo-embolism. Conclusion: When thromboprophylaxis fails, intervention procedure like IVC filter can be an effective modality of treatment in venous thrombosis.

Amoebiasis cutis: clinical suspicion is the key to early diagnosis.

Amoebiasis cutis is a rare manifestation of Entamoeba histolytica, primarily an intestinal pathogen, which occurs as a complication of amoebic dysentery. Primary cutaneous amoebiasis occurs from contamination of pre-existing wounds. A high degree of clinical suspicion and demonstration of trophozoites from lesions are important for making an early diagnosis lest these patients should suffer significant morbidity. A HIV-negative and otherwise healthy 40-year-old man presented with a well-defined, indurated, painful, progressively enlarging plaque with overlying ulcers and pus discharging sinuses involving buttocks, perianal/perineal area and part of the left thigh of 3 years' duration. A wide array of investigations was unhelpful but demonstration of Entamoeba histolytica trophozoites in wet-drop preparation from the ulcer margin was diagnostic. The trophozoites were also visualized both in H&E and periodic acid Schiff-stained histological sections. Resolution of lesion was observed 2 weeks after treatment with oral metronidazole 800 mg three times a day and wound care.

The Role of MGIT 960 Culture Medium in Resolving the Diagnostic Dilemma for Genital Tuberculosis Patients Presenting with Infertility.

BACKGROUND: The purpose of this study was to assess the utility of Mycobacteria Growth Indicator Tube (MGIT) 960 culture medium for the diagnosis of genital tuberculosis (GTB) in women presenting with infertility. METHODS: The premenstrual endometrial biopsy samples in 300 women presenting with primary and secondary infertility were subjected to AFB smear method, histopathological examination and culture on LJ and MGIT 960 media. Detection rates were compared for diagnostic modalities and their combinations. RESULTS: In total, 30 cases were positive for genital tuberculosis by either of the four tests employed. The detection rates for AFB smear, MGIT culture, LJ culture and HPE were 50, 46.7, 3.3 and 33.3%, respectively. A combination of smear examination for AFB, MGIT 960 culture and histopathological examination was able to detect all the positive cases. A combination of MGIT and LJ media provided no added advantage over MGIT alone since the only case where LJ culture was positive had been detected by positive MGIT culture. In as many as five positive cases (16.7%), only MGIT culture was positive. CONCLUSION: The addition of MGIT 960 culture medium to routine battery of investigations in infertility patients significantly improves the diagnosis.

Seroprevalence of hepatitis C virus (HCV) in health care workers of a tertiary care centre in New Delhi.

Hepatitis C virus (HCV) is a parenterally transmitted virus that poses an occupational hazard to the health care workers (HCWs). No significant data are available regarding the prevalence of HCV in health care workers in India. The present study was designed to determine the seroprevalence of HCV infection in health care workers in a tertiary care centre in New Delhi. The subjects (n=100) were divided according to the duration of employment and the unit where they were working. Blood samples were collected from all the subjects and sera were tested for anti-HCV antibodies. The seroprevalence of anti-HCV was found to be 4 per cent. The duration of occupational exposure was not a significant risk factor for HCV infection and prevalence of anti-HCV antibodies were highest in HCWs working in haemodialysis units. The seroprevalence of HCV in health care workers was considerably higher than that reported in the general population, and needs to be evaluated on a larger sample.

Creeping Eruption on the Move: A Case Series from Northern India.

Cutaneous larva migrans (CLM) is the most common tropically acquired dermatosis caused by infection with hookworm larvae. It is commonly seen in tropical areas, and in people who have a history of foreign travel and of walking barefoot on sandy soil or beaches. An increased incidence has been seen in non-endemic areas due to change in environmental and behavioral factors. The presence of this entity is questionable in Northern region as the environmental conditions and the type of soil is not favorable, both of which are required for the survival of nematode. We describe a case series of six patients presented during winter season in the outpatient department of Dermatology within a short period of 2 months. We also review the clinical features of various other creeping eruptions and factors that are responsible for boosting infection in North India.

Fruit and food eponyms in dermatology.

Dermatology world is brimming with myriad of interesting clinical conditions, signs and syndromes. It is infinite, which has systemic clinical connotations too. Complicated pronunciations of diagnosis have always placed residents in an intricate state. Each one is trying his best to make this cumbersome subject comparatively more acceptable and convenient. The present paper is an attempt to further simplify the subject by correlating difficult conditions with commonly used and seen things such as fruit and food. A total of 45 dermatological conditions were found to be based on fruit and food eponyms. For example, strawberries can remind us of strawberry gums of Wegener's granulomatosis and strawberry nevus.

Cutaneous Metastasis from Signet-ring Gastric Adenocarcinoma in a Carcinoma En Cuirasse Pattern: An Unusual Clinical-diagnostic Sequence.

Cutaneous metastasis (CM) of gastric adenocarcinoma (ADC) is rare and usually presents late in the course of the disease. We report a rare case of carcinoma en cuirasse (CEC) pattern of CM secondary to gastric malignancy in a 55-year-old male patient-the interesting part being that CM was the first-presenting sign, which on further histopathological and immunohistochemical evaluation led to the diagnosis of hidden gastric carcinoma. The finding of signet ring cells (SRCs) on cutaneous biopsy further added a differential of the rare possibility of primary cutaneous tumors.

Narrowband UVB phototherapy in pityriasis rosea.

OBJECTIVE: Pityriasis rosea (PR) is an acute self-limiting disease. Despite vigorous efforts by generations of researchers since nearly 150 years, present treatment modalities for PR are not very gratifying. Ultraviolet radiation has been recommended in PR, although only a few studies validate this proposal. This study was conducted to explore the therapeutic effect of NBUVB on the symptoms, course, and severity of PR. MATERIALS AND METHODS: This study involved a hundred patients who were randomly divided into two groups, using computer-generated randomization chart. Group A underwent treatment with fixed dose NBUVB of 250 mJ/cm(2) three times (nonconsecutive) a week for 4 weeks. Group B formed the placebo group who did not receive any treatment. The two groups were compared with each other for the intensity of pruritis, course and duration of disease, and PR severity score (PRSS). RESULTS: The t values of improvement in PRSS score in Group A (t = 12.796) were higher as compared with that in Group B (t = 10.066). Similarly, the t value of the pruritus scale in Group A (t = 7.758) was higher than Group B (t = 5.754) indicating the symptomatic improvement in itching. CONCLUSION: Fixed-dose NBUVB phototherapy resulted in marked improvement in the severity and symptoms of the disease as quantitatively assessed by PRSS.

Eyeing the complications of hemodialysis in the eye.

The effect of hemodialysis (HD) on intraocular pressure (IOP) is variable and the exact mechanisms are not clear. Increased, decreased, as well as unchanged IOP has been described during HD in various case reports and studies. Patients with certain types of glaucoma and aqueous outflow obstruction of any other cause might be more susceptible to increase in IOP. This can cause severe eye pain, blurry vision, and headaches, causing significant morbidity for such dialysis patients. Certain changes in dialysis prescription may help relieve the above symptoms. There is a lack of awareness among nephrologists about the effects of HD on IOP. This may be especially relevant in the African American patients who besides having a higher risk of developing end-stage renal disease also have a higher risk of developing glaucoma. Recognition as well as management of signs and symptoms of elevated IOP in the dialysis population is significant morbidity and unnecessary work-up.

Animals eponyms in dermatology.

The world of Dermatology is flooded with inflexions among clinical conditions and signs and syndromes; making it interesting, but a tougher subject to remember. Signs and syndromes have always fascinated residents, but simultaneously burdened their minds, as these attractive names are difficult to remember. This work was undertaken to review dermatological conditions and signs based on commonly encountered daily words and objects like animals, etc. Fifty dermatological conditions were found to be based on animal eponyms. For example, the usage of animal terminology in dermatology like leonine facies is present in leprosy, sarcoidosis, mycosis fungoides (MF), and airborne contact dermatitis (ABCD).

Lyme disease in Haryana, India.

Lyme disease is a multiorgan animal-borne disease caused by the spirochete Borrelia burgdorferi. This case series highlights its presence in Haryana, a nonendemic zone. The first case was a 27-year-old housewife who presented with an annular erythematous patch with a central papule following an insect bite on the left upper arm. The second case was a 32-year-old farmer who gave a history of insect bite on the right arm followed by the development of an erythematous patch with a central blister. The third case, a 17-year-old boy presented with a history of tick bite over right thigh and a typical bull's eye lesion with central ulceration. These cases were managed with oral doxycycline 100 mg twice daily for 14 days. The fourth case was a 7-year-old boy with typical erythema migrans on the right check and neck while the fifth case, a 30-year-old housewife, presented with an erythematous patch with a central papule on the right buttock. These patients were treated with oral amoxycillin 25 mg/kg, thrice daily for 14 days. All patients showed IgM antibodies to B. burgdorferi. Treatment led to clearance of lesions in all the patients. Lyme borreliosis was diagnosed in these patients based on the history of established exposure to tick bites, presence of classic signs and symptoms, serology and the response to treatment.