Gynaecomastia with oligospermia: an unusual complication of low-dose methotrexate for pustular psoriasis.
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Biomedical subjects
Publications and source records attributed to A Singal.
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Sarcoidosis is a rare disease among children, manifesting differently in children below and above 4-5 years of age. Although the exact incidence and prevalence of childhood sarcoidosis is not known, the cutaneous involvement is frequent in both children and adults. Infiltration of old cutaneous scars with sarcoid granuloma in the active phase of disease, known as scar sarcoidosis is one of the uncommon cutaneous manifestations of sarcoidosis. We report a case of scar sarcoidosis in an 11-year-old child along with a brief review of the literature.
AIM: The value of polythene film ('cling wrap') to improve thermal control and reduce postnatal weight loss in preterm, very low-birthweight babies was investigated. METHODS: Consecutively born babies with birthweights between 750 and 1500 g were stratified by birthweight (<1250 g, 1251-1500 g) and randomised either to the cling wrap (CW) or no cling wrap (NCW) group. The baby bassinette of the RW was covered with cling wrap up to the level of the neck in the CW group for the 1st 7 days. The primary outcome variables were the incidence of hypothermia (axillary temperature < or = 36 degrees C) after initial stabilisation during the first 7 days and cumulative weight loss (percentage of birthweight) at 48 hours of age. RESULTS: Of 51 babies, 26 were randomised to the CW and 25 to the NCW group. None of the babies in the CW group developed hypothermia in the 1st 7 days but 36% in the NCW group (p = 0.001) did. Babies who were hypothermic on admission took less time to reach normal temperature in the CW group. Cumulative weight loss in the 1st 48 hours was 5.0 + 5.6% in the CW group and 8.6 + 7.0% in the NCW group (p = 0.06). CONCLUSION: Use of CW might be a simple method of maintaining temperature in very low-birthweight babies in developing countries.
We report a 27-year-old primigravida with systemic lupus erythematosus, erythema multiforme-like lesions and a peculiar immunological pattern consisting of antinuclear antibody (speckled pattern) and rheumatoid factor, an association known as Rowell's syndrome. She also had a probable antiphospholipid syndrome as evidenced by the presence of a prolonged activated partial thromboplastin time, kaolin clotting time and thrombocytopenia.
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BACKGROUND: A number of sexual and social risk factors for bacterial vaginosis (BV) have been identified. However, many previous studies have used small numbers of patients, or highly selected or convenience samples, or poorly defined populations. This study aims to clarify potential sexual and non-sexual risk factors for BV. METHODS: Women attending the Sydney Sexual Health Centre with BV, between March 1991 and July 1999, were included. Controls were randomly selected women without BV. Information on the demographics, clinical findings, and sexual and non-sexual risk behaviours were extracted from the clinic database and analysed using SPSS and SAS. A logistic regression model was used to establish which associations with BV persisted. RESULTS: 890 women with BV and 890 controls were studied. Factors that were independently associated with BV were > or =3 male sexual partners in the past 12 months (OR = 1.60, 95% CI: 1.19 to 2.04), at least one female sexual partner in the past 12 months (OR = 2.1, p = 0.003), a past pregnancy (OR = 1.5, p<0.0006), and smoking. In contrast, women with BV were significantly less likely to have used hormonal contraception (OR = 0.60, 95% CI: 0.51 to 0.81) or to have used condoms consistently (OR = 0.5, 95% CI: 0.31 to 0.71) than controls. CONCLUSION: Our findings may be important for planning a preventive strategy for BV by discouraging smoking and increasing condom use and hormonal contraception among women.
One hundred and six consecutive patients (old and newly diagnosed) attending the leprosy clinic at Guru Teg Bahadur Hospital, Delhi, underwent a detailed ophthalmic examination to identify factors associated with the prevalence of sight threatening lesions of leprosy so as to delineate a sub-group of patients who should continue under active ophthalmic surveillance to prevent blindness. All of them were receiving multidrug therapy as recommended by WHO. Demographic data, systemic parameters and ophthalmic lesions attributable to the disease were endorsed on to a proforma. The data were analysed by chi-square test, discriminant analysis and multivariate regression analysis to isolate factors that could be associated with sight threatening lesions of leprosy. In 106 leprosy patients 212 eyes were examined; sight threatening lesions were found in 37 eyes (17.4%). The comea was involved most commonly (78.3%). The lesions were still present in 15.8% of patients who had completed multidrug therapy. Leprosy related visual impairment was seen in 2.3% eyes and blindness in 0.9% eyes. Factors significantly associated with sight threatening lesions included female gender, multibacillary leprosy, increasing duration of leprosy, thickened corneal nerves, subepithelial punctate corneal opacities and presence of any academic lesion of leprosy. On multivariate and discriminant analysis, female gender, thickened corneal nerves and duration of leprosy > 7 years were significantly associated with sight threatening lesions.
Cardiac injury following blunt chest trauma is known to occur, but traumatic rupture of ventricular septum is a rare injury, especially following blunt chest trauma. A case of a 20-year-old male is presented who fell on his back from a 9th-floor window and was resuscitated for 3 hours to no avail. Post-mortem examination confirmed a fracture of the pelvis, pulmonary contusion and rupture of ventricular septum of the heart.
Pityriasis versicolor can be treated by a single or multiple dosage regime of ketoconazole as well as by fluconazole. The therapeutic efficacy of these two drugs has not been compared. One hundred and eighty patients with moderate to extensive pityriasis versicolor confirmed by KOH and Wood's lamp examination were randomly assigned to one of the four oral antifungal regimes: Ketoconazole 400 mg single dose (Category I), Ketoconazole 200 mg daily for 10 days (Category II), Fluconazole 400 mg single dose (Category III) or Fluconazole 150 mg per week for 4 weeks (Category IV). Follow up was done at 2 and 4 weeks and then at 3, 6 and 12 months after the treatment in each group. KOH and Wood's lamp examinations were repeated each time. After four weeks of treatment, clinical cure was observed in 66.6% (Category I), 73.3% (Category II), 80% (Category III) and 59.9% (Category IV) of patients. Mycological cure after four weeks of treatment was observed in 53.3% (Category I), 73.3% (Category II), 82.2% (Category III) and 64.4% (Category IV) of patients. After twelve months of follow-up, maximum relapses were observed with Category I. No relapse was seen in Category III patients. The time period of relapse varied from three to ten months. In conclusion, single dose 400 mg oral fluconazole provided the best clinical as well as mycological cure rate with no relapse during twelve months of follow-up.
There is a paucity of literature on tinea capitis from North India. The response to griseofulvin has not been studied as well. We studied 153 consecutive patients of tinea capitis for clinical patterns, causative dermatophytic species, clinico-etiological correlation, and response to griseofulvin. Culture and sensitivity were done on all patients. All patients were treated with griseofulvin for 6-8 weeks; non-responders were further treated with fluconazole. Ninety percent of the patients were less than 15 years of age, 75% belonged to poor socioeconomic groups and 19% had a family history of tinea capitis. The seborrheic variant was the commonest clinical pattern seen in 47.8% of patients, followed by grey patch, black dot, kerion, and alopecia-areata-like tinea capitis in 35.9%, 8.5%, 6.5% and 1.3% of patients, respectively. Only 66% of patients had a positive culture. T. violaceum was the commonest dermatophytic species isolated in 38% patients. M. audouinii, T. schoenleinii, T. tonsurans, M. gypseum, T. verrucosum and T. mentagrophytes were isolated in 34%, 10%, 9%, 3%, 3% and 3% of patients, respectively. Of the isolates 94% were susceptible to griseofulvin, and 100% were susceptible to fluconazole. By using griseofulvin for 6-8 weeks 97.4% of the patients were cured; nonresponders required therapy with fluconazole for cure. To conclude, tinea capitis is still a disease of younger people of poor socioeconomic status. T. violaceum and M. audouinii are the most common responsible dermatophytes. The response to griseofulvin was excellent, and it should be used as a first line therapy.
Two cases of linear nevus sebaceus syndrome (LNSS) are described in which ipsilateral facial nevus of Jadassohn was associated with complex ocular choristoma. One patient also had scleral osteomas, a rare occurrence in LNSS.
Intracellular calcium handling plays an important role in cardiac electrophysiology. Using two fluorescent indicators, we developed an optical mapping system that is capable of measuring calcium transients and action potentials at 256 recording sites simultaneously from the intact guinea pig heart. On the basis of in vitro measurements of dye excitation and emission spectra, excitation and emission filters at 515 +/- 5 and >695 nm, respectively, were used to measure action potentials with di-4-ANEPPS, and excitation and emission filters at 365 +/- 25 and 485 +/- 5 nm, respectively, were used to measure calcium transients with indo 1. The percent error due to spectral overlap was small when action potentials were measured (1.7 +/- 1.0%, n = 3) and negligible when calcium transients were measured (0%, n = 3). Recordings of calcium transients, action potentials, and isochrone maps of depolarization time and the time of calcium transient onset indicated negligible error due to fluorescence emission overlap. These data demonstrate that the error due to spectral overlap of indo 1 and di-4-ANEPPS is sufficiently small, such that optical mapping techniques can be used to measure calcium transients and action potentials simultaneously in the intact heart.
Although many cell fates differ between males and females, probably the most ancient type of sexual dimorphism is the decision of germ cells to develop as sperm or as oocytes. Genetic analyses of Caenorhabditis elegans suggest that fog-3 might directly control this decision. We used transformation rescue to clone the fog-3 gene and show that it produces a single major transcript of approximately 1150 nucleotides. This transcript is predicted to encode a protein of 263 amino acids. One mutation causes a frame shift at the sixth codon and is thus likely to define the null phenotype of fog-3. Although the carboxyl-terminus of FOG-3 is novel, the amino-terminal domain is similar to that of the Tob, BTG1, and BTG2 proteins from vertebrates, which might suppress proliferation or promote differentiation. This domain is essential for FOG-3 activity, since six of eight missense mutations map to this region. Furthermore, this domain of BTG1 and BTG2 interacts with a transcriptional regulatory complex that has been conserved in all eukaryotes. Thus, one possibility is that FOG-3 controls transcription of genes required for germ cells to initiate spermatogenesis rather than oogenesis. This model implies that FOG-3 is required throughout an animal's life for germ cells to initiate spermatogenesis. We used RNA-mediated interference to demonstrate that fog-3 is indeed required continuously, which is consistent with this model.
BACKGROUND: Intraoperative hyperthermic peritoneal chemotherapy (IHPC) after total gastrectomy for advanced, serosa-penetrating gastric cancer has been demonstrated in several studies to reduce the incidence of peritoneal carcinosis and to prolong survival. METHODS: In a prospective pilot study, nine patients with advanced gastric cancer were selected to receive IHPC with Mitomycin and Cisplatin after total gastrectomy and systematic lymphadenectomy. RESULTS: All patients had nodal, and four patients distant, metastases. Six patients (66%) suffered from post-operative complications including renal failure, pancreatitis, pancreatic fistula and anastomotic dehiscence. Thirty-day mortality was zero. Six patients died within 3-10 months after surgery. Five of these deaths were related to peritoneal carcinosis and one patient died from cardiac failure 3 months after surgery. Three patients, respectively, have been alive for 12, 20 and 24 months at present, with suspected peritoneal tumour in the last patient. The 2-year probability of survival among our patients receiving IHPC is 29%. CONCLUSION: Intraoperative hyperthermic peritoneal chemotherapy carries a high risk of peri-operative complications and was not able to prevent or delay peritoneal tumour recurrence in patients with advanced gastric cancer.
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We report a case of extensive subcutaneous and muscle fibrosis in a 26-year-old Indian woman caused by repeated intramuscular pentazocine injections over five years to highlight the extent and sequelae of this avoidable condition.
Reticulate acropigmentation of Kitamura (RAK) in three patients and their families is described. In one family, 2 women and 2 men were affected out of 9 individuals. In the other family, 6 women had lesions of reticulate acropigmentation out of total of 27 over three generations. In the third family, one man was affected. All of the cases had palmar pits; onset of lesions was after puberty in all the cases. The apparently different hereditary patterns in these three families are striking, and autosomal dominant inheritance appears unlikely in every case.
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